Galeazzi Fracture: Causes, Symptoms, Diagnosis, Treatment & Physiotherapy Management

Galeazzi Fracture: Causes, Symptoms, Diagnosis, Treatment & Physiotherapy Management

Introduction

A Galeazzi fracture is a unique and unstable forearm injury that involves a fracture of the distal third of the radius along with dislocation of the distal radioulnar joint (DRUJ).
Known as the “fracture of necessity,” this injury almost always requires surgical management in adults.

This fracture was first described by the Italian surgeon Riccardo Galeazzi, and it remains an important orthopedic emergency due to the complexity of bone and ligament damage involved.

Galeazzi Fracture


What is a Galeazzi Fracture?

A typical Galeazzi fracture involves:

1. Distal Radius Fracture

  • Usually at the junction of the middle and distal third of the radius

2. DRUJ Dislocation

  • The ulnar head becomes displaced

  • DRUJ stability is disrupted

This combination makes the injury highly unstable.

Mechanism of Injury

Galeazzi fractures occur due to:

  • Fall on an outstretched hand (FOOSH) with forced pronation

  • Road traffic accidents

  • Sports trauma

  • Direct blow to the forearm

High-energy trauma is the most common cause.

Clinical Features

Symptoms

  • Severe wrist and forearm pain

  • Visible deformity

  • Swelling and bruising

  • Pain during pronation/supination

  • Weak grip strength

Signs on Examination

  • Prominent ulnar head

  • Tenderness over distal radius and DRUJ

  • Instability of the wrist

  • Limited range of motion

  • Check for neurovascular deficits (median and radial nerve)

Diagnosis

1. X-Rays

  • Confirm radial fracture

  • Show DRUJ displacement

  • Look for widening of joint space and ulnar styloid fractures

2. CT Scan

Useful when:

  • DRUJ instability is unclear

  • Complex fracture patterns exist

3. Clinical Tests

  • Piano key sign

  • DRUJ ballottement test

Treatment & Medical Management

Adults

Because Galeazzi fractures are unstable in adults, surgery is the gold standard.

1. ORIF (Open Reduction and Internal Fixation)

  • Fixation of the radius using plates and screws

  • Reduction of the DRUJ

  • If DRUJ remains unstable, temporary K-wire fixation is used

2. Immobilization

  • Above-elbow splint for 4–6 weeks

  • Forearm placed in supination (especially for dorsal DRUJ dislocation)

Children

  • Closed reduction

  • Above-elbow cast

  • Surgery rarely needed

Complications

If not treated early and correctly, Galeazzi fractures may lead to:

  • Chronic DRUJ instability

  • Decreased forearm rotation

  • Malunion / nonunion

  • Nerve palsies

  • Persistent wrist pain

  • Compartment syndrome

Prognosis

With early surgery and proper physiotherapy, patients usually recover 80–95% of their functional strength and wrist mobility.

Physiotherapy Management of Galeazzi Fracture

Physiotherapy plays a crucial role after immobilization or surgery to restore mobility, strength, and functional use of the forearm and wrist.

Physiotherapy management is divided into three phases:

Phase 1: Immobilization Phase (0–4 weeks)

(May vary depending on surgeon instructions)

Goals:

  • Reduce pain and swelling

  • Prevent stiffness of fingers, shoulder, and elbow

  • Protect surgical repair

Physiotherapy Techniques:

1. Edema and Pain Control

  • Ice therapy (around cast/splint)

  • Elevation of hand

  • Gentle retrograde massage

2. Finger Mobility

  • Active finger flexion and extension

  • Tendon gliding exercises

    • Hook fist

    • Straight fist

    • Composite fist

3. Shoulder & Elbow Mobility

  • Shoulder pendulum exercises

  • Elbow flexion-extension (if allowed)

  • Avoid forearm rotation unless cleared by the surgeon

4. Isometric Exercises

  • Grip strengthening using a soft ball

  • Wrist isometrics (in cast/splint)

    • Flexion

    • Extension

    • Radial/ulnar deviation

Phase 2: Mobilization Phase (4–8 weeks)

(After cast removal)

Goals:

  • Restore wrist and forearm ROM

  • Improve soft tissue mobility

  • Reduce stiffness

Physiotherapy Techniques:

1. ROM Exercises

  • Wrist flexion/extension

  • Wrist radial/ulnar deviation

  • Forearm pronation/supination

  • Elbow and shoulder full ROM

2. Joint Mobilizations

(Performed by a therapist)

  • DRUJ mobilization

  • Radiocarpal joint mobilization

  • Intercarpal glides

3. Stretching

  • Wrist flexor & extensor stretches

  • Forearm rotational stretching (gentle)

4. Strengthening (Light Resistance)

  • Wrist flexion/extension using theraband

  • Grip strengthening

  • Pronation/supination using a hammer or stick

  • Forearm isometrics

Phase 3: Strengthening & Functional Phase (8–12+ weeks)

Goals:

  • Restore full strength and endurance

  • Improve functional activities

  • Return to sports, work, or daily tasks

Physiotherapy Techniques:

1. Advanced Strengthening

  • Dumbbell wrist curls

  • Reverse wrist curls

  • Pronation/supination with resistance band

  • Wrist stabilization exercises

2. Proprioception Training

  • Ball catching/throwing

  • Weight-bearing on hands

  • Balance board or wobble board (upper limb version)

3. Functional Training

  • Return-to-work tasks

  • Sports-specific drills

  • Hand dexterity tasks (putty exercises, squeezing, pinching)

4. Manual Therapy

  • Soft tissue release

  • Scar mobilization

  • Myofascial release

When to Return to Activities?

  • Light work: 8–10 weeks

  • Heavy lifting: 12–14 weeks

  • Sports: 3–6 months (depending on healing and strength)

Return should be gradual and guided by a physiotherapist and surgeon.

PubMed References

  1. Mikic ZD. Galeazzi fracture-dislocations. J Bone Joint Surg Am. 1975;57(8):1071–1080.
    PubMed PMID: 1192644

  2. Giannoulis FS, Sotereanos DG. Galeazzi fractures and dislocations. Hand Clin. 2007;23(2):153–163.
    PubMed PMID: 17548017

  3. Kang S, et al. Distal radioulnar joint instability associated with distal radius fractures. Clin Orthop Surg. 2014;6(3):253–259.
    PubMed PMID: 25177466

  4. Moore TM, et al. Results of treatment of Galeazzi fractures. J Trauma. 1985;25(3):285–289.
    PubMed PMID: 3980382

  5. Sotereanos DG, et al. The Galeazzi fracture: a review of 109 patients. J Hand Surg Am. 1995;20(4):613–617.
    PubMed PMID: 7594277

  6. Schroeder JD, et al. Pediatric Galeazzi fracture-dislocations: conservative vs. surgical management. J Pediatr Orthop. 2007;27(7):795–798.
    PubMed PMID: 18043385

  7. Ring D. Fractures of the distal radius and ulna. J Hand Surg Am. 2003;28(3):367–379.
    PubMed PMID: 12772122

Conclusion

A Galeazzi fracture is a severe injury involving a distal radius fracture with DRUJ dislocation. Prompt diagnosis, surgical fixation, and structured physiotherapy are essential for full recovery.
Through proper rehabilitation—including mobility exercises, strengthening, and functional training—patients can regain near-normal function and return to daily activities safely.






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