A 28-year-old woman presents with a Galeazzi fracture (fracture of the distal third of the radius with disruption of the distal radioulnar joint). Regarding the clinical features, imaging, and management of Galeazzi fractures, all of the following statements are correct EXCEPT:

Explanation

## Galeazzi Fracture: Anatomy, Diagnosis, and Management **Key Point:** A Galeazzi fracture is a fracture of the distal third of the radius (typically at the junction of middle and distal thirds) combined with disruption of the distal radioulnar joint (DRUJ). It is often called a "fracture of necessity" because it almost always requires surgical fixation. ### Clinical Presentation and Examination **High-Yield:** Classic presentation: - Fall on outstretched hand (FOOSH) with wrist in pronation - Swelling and deformity at the distal forearm - Loss of forearm rotation (pronation/supination) - Tenderness over the distal radioulnar joint **Clinical Pearl:** The **scaphoid shift test (Watson's test)** is a test for scapholunate ligament insufficiency and carpal instability, NOT a characteristic finding in Galeazzi fractures. This is a **trap answer**—students may confuse wrist instability from DRUJ disruption with scapholunate instability. **Mnemonic: DRUJ Findings in Galeazzi —** - **D**orsal prominence of ulnar head (ulna subluxes dorsally) - **R**estoration of DRUJ is essential - **U**lnar-sided wrist pain - **J**oint disruption on imaging ### Imaging Findings **Key Point:** DRUJ dislocation can be subtle and missed on standard radiographs. | View | Finding | |---|---| | **AP forearm** | Radial shaft fracture; DRUJ dislocation may be subtle | | **Lateral forearm** | **Dorsal dislocation of ulna** (most common); may show ulnar head displacement | | **CT or MRI** | Best for assessing DRUJ alignment, TFCC integrity, and soft tissue damage | **High-Yield:** A **lateral radiograph is essential** to visualize the dorsal displacement of the ulnar head. Relying on AP views alone will miss the DRUJ dislocation in up to 25% of cases. ### Soft Tissue Injury **Key Point:** Galeazzi fractures involve disruption of: 1. **Interosseous membrane (IOM)** — torn, leading to loss of load transfer between radius and ulna 2. **Triangular fibrocartilage complex (TFCC)** — disrupted, causing DRUJ instability 3. **Dorsal and volar radioulnar ligaments** — stretched or torn These injuries are why closed reduction alone fails—the soft tissue damage prevents stable reduction. ### Management Algorithm ```mermaid flowchart TD A[Galeazzi Fracture]:::outcome --> B{Fracture characteristics?}:::decision B -->|Minimally displaced| C[Attempt closed reduction]:::action B -->|Displaced/angulated| D[ORIF indicated]:::action C --> E{Stable reduction?}:::decision E -->|Yes| F[Long-arm cast, weekly X-rays]:::action E -->|No| D D --> G[ORIF radius + DRUJ reduction]:::action G --> H[Percutaneous pinning or TFCC repair]:::action H --> I[Functional outcome restored]:::outcome ``` **High-Yield:** Most Galeazzi fractures require **open reduction internal fixation (ORIF)** because: - Closed reduction is unstable due to soft tissue disruption - The DRUJ must be anatomically reduced to restore pronation/supination - Percutaneous pinning (K-wires) across the DRUJ may be needed for 4–6 weeks ### Why Scaphoid Shift Test is Wrong **Warning:** The **scaphoid shift test (Watson's test)** assesses for **scapholunate ligament insufficiency**, which is a separate carpal instability pattern. It is NOT a characteristic finding in Galeazzi fractures. Galeazzi fractures cause: - DRUJ instability (not scapholunate instability) - Loss of forearm rotation - Ulnar-sided wrist pain Confusing these two conditions is a common trap in orthopedic exams.