Patient Information Resources

Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

View Web RX

« Back

I'm in the middle of a nasty lawsuit looking for some information. Two years ago, I broke my wrist and damaged the distal ulnar-radial junction. The problem was misdiagnosed and mismanaged. I finally found out I had a Galeazzi fracture that required surgery. Now that that's behind me, I'm asking for damages because I have constant pain and lost motion. Is this really a difficult problem to diagnose?

There are several different types of fractures that affect the wrist. A recent article focused on fractures of the joint between the two bones of the forearm (the radius and the ulna) may help you. Those two bones meet at the elbow and at the wrist. That particular joint at the wrist is called the distal radioulnar joint or DRUJ. A fracture that disrupts the DRUJ is called a galeazzi fracture. In this article, orthopedic hand surgeons present a review of Galeazzi fractures from top to bottom. They begin with a description of the fracture, review the anatomy, and describe the mechanism of injury that causes these fractures. From there, they cover diagnosis and treatment with a follow-up on complications and prognosis. This article will help you understand all the complexities of the injury. But to answer your question now, an accurate diagnosis can be extremely difficult. In most cases, after hearing the history of what happened and examining the injury, the surgeon will order X-rays. Studies show that 20 per cent of patients with a true distal radioulnar joint (DRUJ) injury won't show up on an X-ray. CT scans aren't routinely ordered but may be necessary. The value of MRIs in making the diagnosis hasn't been studied or proven. The authors say it's easy to miss suble distal radioulnar joint injuries. This is true even when other soft tissue structures are also compromised as is often the case. For example, the fracture can cause a disruption of the joint where the radius and ulna are connected together. The interosseous membrane -- ligaments that hold the two bones together is also torn. Along with dislocation of the two bones comes a rupture of the fibrous cartilage where the two bones meet the carpal (wrist) bones. The soft tissue at that junction is called the triangular fibrocartilage or TFCC. If that's not bad enough, without this important soft tissue structure, the fractured radial bone jams up on itself causing a shortening of the bone. Muscles in the forearm add their own forces on the broken bone causing further deformities. Sometimes it's not until the surgeon performs an open procedure the truth of all that's been damaged is revealed. And in some cases, it's not until surgery appears to fail to relieve pain or loss of function that a closer examination reveals the full extent of the problem. For the adult with a Galeazzi fracture, a procedure called open reduction and internal fixation or ORIF is almost always required. These fractures are very unstable in adults and don't respond well at all to conservative (nonoperative) care. In adults, the weight of the hand and the strength of the muscles pulling on the broken bones are just too much to allow for a good result using the same treatment approach as with children. As you can probably tell, final results or outcomes (prognosis) depend on severity of the injury and any complications that may arise during or after surgery. Nerve damage, failure of the bone to heal, deformities, and chronic pain are just some of the problems that can develop. Sometimes more than one surgery is required to stabilize the joint. The goal is always to reduce pain, improve motion, and restore function. Cosmetics may have to take a back seat if the surgeon has to choose between form and function.


« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.