History of present illness:
A 19-year-old male presented to the ED with right forearm pain after being struck in the forearm by a baseball. The patient then threw the ball and felt a sharp “pop” in his arm. The patient complained of sharp pain, worse with movement. Upon examination, the patient was neurovascularly intact.
The X-ray showed an acute comminuted fracture of the distal diaphysis of the radius with disruption of the distal radioulnar joint, consistent with a Galeazzi fracture. The patient was then splinted and taken for operative reduction and internal fixation the following day.
Most forearm fractures are caused by a sudden force, such as a fall on an outstretched arm.1 Bones of the forearm (radius and ulna) lie in parallel and are connected by joint capsules at the elbow and wrist, with the shafts interlocked by a fibrous interosseous membrane. Due to this, multiple fractures and concurrent dislocations may be present. A Galeazzi fracture is a distal radial shaft fracture with concurrent distal radioulnar dislocation. They are two to three times more common than Monteggia fractures (which is a proximal ulnar fracture with dislocation of radial head)2 and have a potential for higher morbidity. Disruption of the radioulnar joint must be suspected in patients with a fracture of the ulnar styloid, midshaft radius, or those with shortening of the radius or widening of the radioulnar joint.3 Galeazzi fractures require orthopedic consultation as they will likely require ORIF for repair, since anatomic reduction of the distal radial-ulnar joint is required.3
Forearm fracture, Galeazzi fracture.
- Williams DT, Kim HT. Wrist and forearm. In: Marx J, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 8th Philadelphia, PA: Elsevier; 2014:570-596.
- Mills TJ and DeBlieux P. Forearm fracture, shaft/distal. In: Rosen P, Barkin R, Hayden S, Schaider J, Wolfe R, eds.Rosen & Barkin’s 5-Minute Emergency Medicine Consult. 4th Philadelphia PA: Lippincott Williams & Wilkins; 2011:418-419.
- Mills TJ. Forearm fractures. In: Adams JG, Barton ED, Collings JL, DeBlieux PM, Gisondi MA, Nadel ES, eds. Emergency Medicine: Clinical Essentials. 2nd Philadelphia PA: Elsevier; 2013:776-780.