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Distal Radius Fracture with Unrecognized DRUJ Dislocation: Misdiagnosed Galeazzi Injuries in Children
Andrew Kim, BA, Sayaka Mori, BA, Elizabeth M Wacker, MD; Apurva S. Shah, MD, MBA
Children's Hospital of Philadelphia, Philadelphia, PA
Introduction: Pediatric Galeazzi and Galeazzi-equivalent fracture-dislocations are often overlooked, leading to delayed treatment and potentially debilitating outcomes such as malunion, distal radioulnar joint (DRUJ) instability, and restricted range of motion. We aimed to characterize the presentation, treatment, and prognosis of these injuries at a tertiary pediatric hospital.
Materials & Methods: We conducted a single-center, retrospective case series of all patients ?18 years old with Galeazzi or Galeazzi-equivalent injuries. Demographic and clinical data were extracted from medical records. Forearm radiographs were reviewed using Rettig and Raskin, and Korompilias classifications. Descriptive statistics are reported as mean ± SD for continuous variables and n (%) for categorical variables.
Results: 21 patients (12 Galeazzi, 9 Galeazzi-equivalent) were included; 15 (71%) were male, with a mean age of 13.9 ± 2.4 years. Average time to diagnosis from initial presentation was 16 ± 41.5 days. Only 8 (38%) were diagnosed at initial presentation, 4 at a later visit, and 9 (43%) were never formally diagnosed. Three with delayed diagnosis required surgery after failed conservative treatment due to DRUJ instability, loss of reduction, or malunion [corrective osteotomy (n=2), ORIF (n=1), TFCC repair (n=1)]. DRUJ dislocation was present in 13 patients, most commonly with dorsal ulnar dislocation (85%). 12 patients had 14 concomitant ulnar fractures: 10 physeal, 3 styloid, and 1 diaphyseal. Most common Rettig and Raskin and Korompilias classifications were type I (76% and 81%, respectively). Mean distance from the fracture to the mid-articular surface of the distal radius was 47.0 ± 27.7 mm. 17 patients (81%) underwent attempted closed reduction and 15 (71%) required surgery. Radius fixation constructs included plates/screws (53%), intramedullary nails (13%), and wires (13%). The DRUJ was most often stabilized with wires (33%). Mean operative time was 73.3 ± 29.4 minutes. At final follow-up (mean 170.5 ± 163.4 days), mean wrist flexion, extension, supination, and pronation were 62.7 ± 8.0°, 63 ± 8.0°, 89.7 ± 3.0°, and 85.3 ± 12.0°, respectively.
Conclusion: Galeazzi/Galeazzi-equivalent fracture-dislocations are frequently missed, with only 38% diagnosed at initial visit. Delayed recognition led to surgery in 23% of missed cases. Although most patients achieved near-full recovery of wrist range of motion, early identification remains critical to avoid preventable complications. Improved awareness and recognition of these rare injuries may facilitate timely diagnosis and optimized management.
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