Diagnosis and Management of Galeazzi Fracture: A Narrative Review

Abstract

Background: The Galeazzi fracture is a distinctive forearm injury combining a fracture of the middle to distal third of the radial shaft with disruption, subluxation, or dislocation of the distal radioulnar joint (DRUJ). Long recognised as a “fracture of necessity” in adults, it carries a high risk of malunion, chronic DRUJ instability, and permanent loss of forearm rotation when treated non-operatively, with reported failure rates of 80–92% for closed management in this age group. Methods: This narrative review synthesises current evidence on the definition, historical background, and clinical variants of the Galeazzi fracture, including the paediatric Galeazzi-equivalent lesion, drawn from the anatomical, biomechanical, and clinical literature on its diagnosis and management. Results: The regional anatomy and biomechanics of the interosseous membrane and triangular fibrocartilage complex (TFCC) that govern forearm rotation and DRUJ stability are discussed, together with the muscular deforming forces that make closed reduction unreliable in adults. Clinical examination findings, radiographic and advanced imaging criteria for occult DRUJ instability, and the major classification systems (Walsh, Rettig and Raskin, Macule Beneyto, Bruckner, and AO/OTA) used to guide treatment decisions are reviewed. Management is presented separately for the paediatric and adult populations: closed reduction and cast immobilization remain effective in children, whereas open reduction and internal fixation (ORIF) of the radius, together with systematic intraoperative assessment and stabilisation of the DRUJ, is the standard of care in adults. Surgical approaches (Thompson dorsal and Henry volar), fixation technique, and salvage options for neglected or malunited injuries, including ulnar shortening osteotomy, the Sauvé–Kapandji procedure, and the Darrach procedure, are also summarised, along with common complications and prognosis. Conclusion: Accurate recognition of DRUJ injury at initial presentation, meticulous anatomical reduction of the radius, and structured intraoperative evaluation of DRUJ stability remain the cornerstones of a good functional outcome.