A 28-year-old woman sustains a fall on an outstretched hand with the forearm in supination. Imaging shows a fracture of the distal third of the radius with volar displacement and an associated dislocation of the distal radioulnar joint (DRUJ). Which of the following is NOT a characteristic feature of a Galeazzi fracture?

Explanation

## Galeazzi Fracture: Definition and Key Features **Key Point:** A Galeazzi fracture is a fracture of the distal third of the radius combined with dislocation of the distal radioulnar joint (DRUJ). It represents 3–6% of forearm fractures and is often unstable. ### Anatomical and Mechanical Features **High-Yield:** The critical distinguishing feature is the location of the radial fracture: - **Distal third of radius** (typically at or distal to the pronator quadratus insertion) - The fracture line is usually oblique or transverse - Disruption of the interosseous membrane and DRUJ ligaments occurs ### DRUJ Dislocation Direction **Clinical Pearl:** The DRUJ dislocation in Galeazzi fractures is **VOLAR (anterior)**, NOT dorsal. This is a critical distinction from other forearm injuries: - The ulnar head is displaced **anteriorly/volarly** - This occurs because the mechanism (supination + wrist extension) forces the ulna forward relative to the radius - Dorsal DRUJ dislocation is seen in other injuries (e.g., Essex-Lopresti fracture-dislocation) ### Mechanism of Injury 1. Fall on outstretched hand with **forearm supinated** 2. Wrist extension force 3. Results in distal radial fracture + volar DRUJ dislocation ### Treatment Principles **High-Yield:** Galeazzi fractures are called "fractures of necessity" because they almost always require operative fixation: - Closed reduction is often unstable and fails - ORIF of the radius (plate fixation) is standard - DRUJ reduction and stabilization (pinning, suture repair, or arthroscopic assessment) is essential - Non-operative treatment has high rates of malunion and chronic DRUJ instability ### Why Option 1 Is Wrong Option 1 states the DRUJ dislocation is "usually dorsal, with the ulnar head displaced posteriorly." This is **incorrect**. In Galeazzi fractures, the DRUJ dislocation is **volar (anterior)**, with the ulnar head displaced anteriorly. Dorsal DRUJ dislocation occurs in different injury patterns (e.g., Essex-Lopresti). This is a high-yield distinction that examiners frequently test.