Anteroposterior x-ray of a 67-year-old man’s right wrist injured during a snowmobiling accident.
Lateral x-ray of the man’s right wrist.
Anteroposterior x-ray of the man’s affected forearm.
A 67-year-old man presents to the emergency room after injuring his right wrist during a snowmobiling accident. On examination, the patient has an obvious deformity to the right distal radius. Motor function, sensation, and skin are all intact. X-rays are taken.
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A Galeazzi fracture is defined as a distal one-third radius fracture with associated disruption of the distal radioulnar joint (DRUJ). Radioulnar instability occurs as a result of injury to the dorsal and volar radioulnar ligaments, which are the primary stabilizers of the DRUJ. The most common mechanism of injury is a fall with an outstretched hand. X-ray findings associated with a DRUJ injury include a widened DRUJ on anteroposterior x-ray, dorsal or volar displacement of the ulna on the lateral view, and radial shortening of more than 5 mm.1
Open reduction and internal fixation with plate and screw fixation is required for all Galeazzi fractures. Once the distal radius fracture is fixed, the DRUJ should be stressed to see if instability remains. The DRUJ is stressed in supination and pronation under fluoroscopy to determine stability. A piano key sign is a simple and reliable clinical finding to assess for DRUJ instability. The examination is positive when a prominent distal ulna, when depressed, returns to a displaced position much like a piano key returns to position after being depressed. If DRUJ instability remains after fixation of the radius, Kirschner wire fixation may be necessary to maintain reduction of the DRUJ joint.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
- Orthobullets. Galeazzi fracture. Available at http://www.orthobullets.com/trauma/1029/galeazzi-fractures. Accessed March 22, 2016.
- Koval KJ, Zuckerman JD. Handbook of Fractures, 3rd Edition. Philadelphia, PA: Lippincott Williams & Wilkins, 2006.