Galeazzi Fracture

A Galeazzi fracture refers to a specific type of forearm fracture involving both the radius (one of the two forearm bones) and the distal ulna (the lower arm bone on the pinky finger side). This fracture pattern is named after the Italian surgeon Ricardo Galeazzi who first described it.

There can be many causes for Galeazzi fracture. A few causes are given below:

1: A fall on an outstretched hand,
2: Direct trauma to the forearm,
3: Combination of axial loading and rotational forces applied to the forearm, etc.

The symptoms of Galeazzi fracture vary depending on the patient's condition. A few symptoms are mentioned below:

1: Pain: Patients experience pain in the forearm, particularly at the fracture site.
2: Swelling and Bruising: Swelling and bruising may occur around the injured area.
3: Deformity: There may be an obvious deformity or shortening of the forearm.
4: Limited Range of Motion: The wrist or elbow movement may be restricted.
5: Tenderness: The affected area is tender to touch.

Pathology:
The Galeazzi fracture is characterized by a fracture of the radius along with dislocation of the distal radioulnar joint (DRUJ). The distal radioulnar joint is where the radius and ulna bones meet at the wrist. The injury disrupts the normal anatomy and function of the forearm, affecting both bones and the joints between them.

Clinical Examination:
The healthcare provider will inquire about the circumstances leading to the injury, such as a fall or trauma to the forearm.

Physical Examination:
The physician will conduct a thorough physical examination, assessing for signs of pain, swelling, deformity, tenderness, and limited range of motion in the forearm and wrist.

X-rays:
X-rays are a key diagnostic tool for assessing fractures. Anteroposterior (AP) and lateral X-rays of the forearm are commonly obtained. These images can help identify the presence of a fracture in the radius and any associated displacement or dislocation of the distal radioulnar joint (DRUJ).

CT Scan:
In complex cases or when the fracture is not clearly visible on standard X-rays, a computed tomography (CT) scan may be performed to provide more detailed images of the bones and joints.

MRI (Magnetic Resonance Imaging):
MRI may be used to assess soft tissues, ligaments, and joint structures in more detail.

Functional Assessment:
The physician may also assess the function and stability of the wrist and forearm, looking for any signs of instability or abnormal movement in the distal radioulnar joint.

Medication: Codeine, Acetaminophen, Tylenol, Cetafen, etc
(Note: Medication should not be taken without the doctor’s prescription)

The treatment for a Galeazzi fracture depends on various factors, including the severity of the fracture, the degree of displacement, and the presence of associated injuries. Treatment options may include conservative (non-surgical) management or surgical intervention. Here are the main approaches to treating Galeazzi fracture:

Closed Reduction: This involves manually manipulating the fractured bones back into their proper alignment. The goal is to restore the normal anatomy of the radius and the distal radioulnar joint (DRUJ).

Surgical Intervention:

1: Open Reduction and Internal Fixation (ORIF): In cases where closed reduction is not possible or if the fracture is unstable, surgical intervention may be necessary. During an ORIF procedure, the surgeon makes an incision to access the fracture site, realigns the bones, and stabilizes them using internal fixation devices such as screws, plates, or rods.

2: Repair of the Distal Radioulnar Joint (DRUJ): If there is a significant disruption of the DRUJ, the surgeon may need to address this during surgery to ensure stability and proper joint function.

Immobilization:
After successful reduction, the forearm is usually immobilized with a cast or splint to allow for proper healing.

Cryotherapy:
Cryotherapy also known as cold therapy helps to reduce inflammation.

Transcutaneous Electrical Nerve Stimulation (TENS):
TENS is used for pain management.TENS units deliver low-level electrical currents through electrodes placed on the skin over the affected area. These electrical impulses can help modulate pain signals and provide relief.

Electrical Muscle Stimulation (EMS) or Neuromuscular Electrical Stimulation (NMES):
To prevent muscle atrophy and improve muscle strength.EMS/NMES devices deliver electrical impulses to stimulate muscle contractions. This is especially important if the patient is immobilized in a cast or splint to prevent disuse atrophy.

Ultrasound Therapy:
Ultrasound is used for deep tissue heating to promote blood flow and accelerate the healing process. High-frequency sound waves are transmitted to the injured area, generating heat that can increase blood circulation and promote tissue repair.

Interferential Current (IFC):
IFC is used for pain relief and muscle stimulation.IFC involves the use of two intersecting medium-frequency electrical currents that produce an interference or beat frequency. This can help reduce pain and promote muscle activity.

Pulsed Electromagnetic Field (PEMF) Therapy:
PEMF is used for its potential benefits in promoting bone healing and reducing inflammation.PEMF devices generate electromagnetic fields that may have positive effects on cellular function, including bone cells involved in the healing process.

Galvanic Stimulation:
Galvanic stimulation is used for edema reduction and pain control. Galvanic stimulation delivers direct current to the tissues, creating a physiological response that can help reduce swelling and modulate pain.

Early Mobilization:
Gentle range of motion exercises for the fingers, hand, and elbow are initiated as early as possible, taking care not to disrupt the healing process of the fractured radius and the distal radioulnar joint.

Manual techniques:
Manual techniques, such as massage or soft tissue mobilization, can also help alleviate pain and reduce muscle tension.

Edema Control:
Techniques like elevation and compression may be employed to manage swelling. Lymphatic drainage and massage may be used to facilitate the removal of excess fluid.

Muscle Strengthening:
Isometric exercises for the forearm muscles are typically introduced early in the rehabilitation process. As healing progresses, resistance exercises may be added to improve strength in the muscles surrounding the wrist, forearm, and elbow.

Joint Mobilization:
Gradual joint mobilization techniques are applied to restore normal movement in the wrist and elbow. Passive and active-assisted range of motion exercises are incorporated to improve flexibility.

Functional Training:
Specific exercises and activities are tailored to address the functional needs of the patient, considering their daily activities and work requirements. Proprioceptive and neuromuscular training may be included to enhance coordination and balance.

Adaptive Techniques:
Patients may be educated on adaptive techniques and modifications to perform daily tasks while minimizing stress on the healing structures.

Patient education is a crucial aspect of the overall management of a Galeazzi fracture. Providing clear and comprehensive information to the patient helps enhance understanding, promote compliance with treatment plans, and empower individuals to actively participate in their recovery. The patient has explained the schedule for follow-up appointments with the therapist and any necessary imaging studies.