A 28-year-old male labourer presents to the emergency department 2 hours after a fall on his outstretched hand (FOOSH) while climbing scaffolding. He reports severe pain in the left forearm with visible deformity. On examination, the wrist is swollen and tender, and there is an obvious dorsal prominence at the wrist. X-rays of the forearm reveal a fracture of the distal radius with dorsal displacement and an associated dislocation of the distal radioulnar joint (DRUJ). 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 an associated dislocation of the distal radioulnar joint (DRUJ). This is a specific and important injury pattern that must be recognized to avoid missed diagnosis. ### Classic Features of Galeazzi Fracture | Feature | Details | |---------|----------| | **Fracture location** | Distal third of radius (usually at junction of middle and distal thirds) | | **Associated injury** | DRUJ dislocation (usually dorsal) | | **Mechanism** | FOOSH with forced pronation or direct blow | | **Clinical presentation** | Wrist swelling, dorsal prominence, forearm deformity | | **Radiographic finding** | Radial fracture + widened DRUJ space on AP view | **High-Yield:** The DRUJ dislocation in Galeazzi fracture is often **missed on initial radiographs** if the wrist is not properly assessed. Always obtain dedicated wrist views (AP, lateral, and pronated grip views) in addition to forearm radiographs. ### Why This Is Galeazzi and Not Other Fractures **Clinical Pearl:** Galeazzi fractures are sometimes called "fractures of necessity" because the DRUJ dislocation is an obligatory component—it cannot be reduced by closed manipulation alone and typically requires surgical fixation. - **Not Monteggia:** Monteggia involves fracture of the **proximal or middle third of the ulna** with anterior dislocation of the radial head. This patient has a distal radius fracture, not an ulnar fracture. - **Not Colles or Smith:** While both involve distal radius fractures, neither is classically associated with DRUJ dislocation as an integral part of the injury pattern. ### Management Principles 1. **Imaging:** AP, lateral, and pronated grip views of the wrist; forearm radiographs to assess fracture location 2. **Reduction:** Closed reduction of radial fracture may partially reduce DRUJ, but surgical fixation is usually required 3. **Fixation:** Intramedullary nailing or plate fixation of radius; DRUJ stability reassessed after radial fixation 4. **Follow-up:** Post-operative imaging to confirm DRUJ reduction and alignment **Mnemonic:** **GALEAZZI = Distal Radius + DRUJ** (Remember: Galeazzi is the **distal** injury; Monteggia is the **proximal** injury) [cite:Rockwood and Green's Fractures in Adults Ch 25]