A 32-year-old man presents to the emergency department following a fall on his outstretched hand while playing cricket. He complains of severe pain and swelling in the left forearm. On examination, there is obvious deformity with the wrist held in a dorsally angulated position. X-ray of the forearm shows a fracture of the distal third of the radius with an associated dislocation of the distal radioulnar joint (DRUJ). The ulna is intact. What is the most likely diagnosis?

Explanation

## Diagnosis: Galeazzi Fracture **Key Point:** A Galeazzi fracture is a fracture of the distal third of the radius with associated dislocation of the distal radioulnar joint (DRUJ). The ulna remains intact, which is the hallmark distinguishing feature. **High-Yield:** The classic triad of Galeazzi fracture: 1. Fracture of the distal third of the radius 2. Dislocation of the DRUJ (usually dorsal) 3. Intact ulna **Clinical Pearl:** Galeazzi fractures are often called "fractures of necessity" because they almost always require operative fixation. Non-operative treatment has a high rate of malunion and loss of pronation/supination. **Mnemonic:** **GALEAZZI = Radius fracture + DRUJ dislocation** ## Mechanism & Pathophysiology The injury typically results from a fall on an outstretched hand (FOOSH) with the forearm in pronation. The force transmitted through the radius causes: - Fracture at the junction of the middle and distal thirds of the radius - Disruption of the interosseous membrane and triangular fibrocartilage complex (TFCC) - Dorsal displacement of the distal radius relative to the ulna ## Management Algorithm ```mermaid flowchart TD A[Galeazzi Fracture Diagnosed]:::outcome --> B{Displacement present?}:::decision B -->|Yes| C[Operative fixation required]:::action B -->|Minimal| D[Consider operative fixation anyway]:::action C --> E[ORIF radius with plate]:::action D --> E E --> F[Restore DRUJ stability]:::action F --> G[Early mobilization]:::action G --> H[Good functional outcome]:::outcome ``` ## Comparison with Similar Injuries | Feature | Galeazzi | Monteggia | Colles | |---------|----------|-----------|--------| | **Bone fractured** | Radius (distal 1/3) | Ulna (proximal 2/3) | Radius (distal 1/3) | | **Associated injury** | DRUJ dislocation | Radial head dislocation | Styloid fracture ± DRUJ | | **Ulna status** | Intact | Fractured | Intact | | **Treatment** | ORIF (almost always) | ORIF or conservative | Conservative or ORIF | **Warning:** Missing the DRUJ dislocation in a Galeazzi fracture is a common error. Always examine the DRUJ carefully and obtain dedicated DRUJ imaging. [cite:Rockwood and Green's Fractures in Adults Ch 26]