Characteristics

• Defined as a fracture of the radius with associated dislocation of the distal radio-ulnar joint.

• Relatively rare fracture occurring in approximately 1 in 14 forearm fractures.

• Occurs in falls onto the outstretched extended hand in which the forearm is forcibly pronated.

• As with Monteggia fractures, it may occur secondary to a direct blow.

Clinical features

• The patient will complain of pain and be reluctant to move the forearm or wrist.

• Obvious deformity at the site of radial fracture may be apparent.

• Tenderness ± fracture crepitus along the distal radius will be present.

• On comparison with the unaffected side, the ulnar head will be prominent with associated soft-tissue swelling.

Radiological features

• Obtain AP and true lateral views of the forearm including the wrist.

• The radius will commonly be fractured at the junction of middle and distal thirds.

• The radius will often appear shortened.

• Carefully assess the distal radioulnar joint (DRUJ) for widening.

• On the lateral view, the head of the ulna will be displaced dorsally.

• Dorsal angulation of the distal radial fragment (apex volar) most likely.

• Ulna styloid fractures are common and act as a marker for distal radioulnar joint disruption.

• A useful way of remembering this type of forearm fracture is with the acronym ‘GFR’ – Galeazzi Fractured Radius.

Management

• ABCs, analgesia and immobilisation initially.

• In adults likely to require ORIF of the radial fracture, which normally corrects the DRUJ abnormality.

• In children, closed reduction under GA will usually suffice, but careful follow up with true lateral radiographs of the wrist are required.

• With late missed injuries, the DRUJ needs stabilisation – such as the Suave–Kapandji procedure – distal ulna osteotomy, partial ulna excision and arthrodesis of the ulnar styloid to the distal radius.