Test 10

In the context of a distal radial fracture, typically at the junction of the middle and distal thirds as in this case, one must carefully assess the distal radioulnar joint (DRUJ) for dislocation as part of the Galeazzi fracture-dislocation pattern. Inspection of the right DRUJ on this anteroposterior (AP) projection reveals that it is dislocated alongside radial shortening (>10 mm suggests complete disruption of the interosseous membrane). The Galeazzi fracture-dislocation complex was confirmed on the contemporaneous lateral projection in this older female teenager. This pattern typically occurs following a fall onto an outstretched hand (FOOSH) with the elbow held in flexion at the time of the injury. Galeazzi fracture-dislocations are unstable injuries which often require ORIF of the radial fracture, assessment and reduction/stabilisation of the DRUJ, and exploration of the triangular fibrocartilage complex (TFCC). In children, remember that Galeazzi-equivalent fractures are those in which there is a distal radius fracture alongside a concomitant (Salter-Harris) fracture of the distal ulnar physis. Recovery may be complicated by physeal arrest of the ulna.