A 12 year old male is brought to the ED after 
injuring his forearm rollerblading.  He fell onto his 
palm and noted pain and a deformity in his forearm.  
Examination revealed normal vital signs and findings 
limited to his left arm.  His clavicle, shoulder, humerus, 
and hand were non-tender.  He was reluctant to move 
his shoulder since his forearm was in a splint and sling.  
There was an obvious angulation at the mid-forearm.  
He could move all his fingers.  No circulatory or sensory
deficits were detected.  Radiographs of his forearm 
were obtained.

View radiographs.


     The radiographs show an angulated distal radius 
and ulna fracture, a fracture through the physis of the 
distal ulna, and a dislocation of the distal ulna 
(radioulnar dislocation).  What type of Salter-Harris 
fracture is present at the distal ulna?  If you have 
difficulty with the Salter-Harris classification, review 
Case 18 (Salter-Harris).  This is probably a SH type I 
fracture, although small parts of the metaphysis may 
still be attached to the fracture segment, making it a 
type II.
     The classic Galeazzi fracture is described as a 
fracture of the distal third of the radius associated with a 
dislocation of the distal ulna.  This classic injury occurs 
more commonly in adults and teenagers than in 
younger children.  It may be very difficult to recognize 
since the radioulnar joint is painful and difficult to 
examine in the presence of an adjacent radius fracture.  
The radioulnar joint may spontaneously reduce in some 
instances.  Orthopedic surgeons usually examine the 
radioulnar joint stability during reduction of the radius 
fracture or by using more advanced imaging methods.  
One should be suspicious of the Galeazzi fracture in 
any angulated fracture of the distal radius.  Radioulnar 
dislocation is unlikely in simple non-angulated 
torus-type distal radius fractures.
     A Galeazzi-like injury occurs in children.  The 
ligaments of the distal forearm normally prevent the 
radius and ulna from twisting about each other.  As the 
distal radius fractures, exaggerated twisting forces in 
the hyperpronation or hypersupination direction result in 
the loss of stabilization of the radioulnar attachments.  
Ligaments attaching the distal ulnar epiphysis to the 
distal radius and the carpal/metacarpals gain tension on 
the ulnar head as twisting occurs.  If the tension force is 
great enough, the ulnar physis fractures.  Recognizing a 
Salter-Harris type I or II fracture of the ulnar physis 
associated with a distal radius fracture should cause 
one to consider the possible complications of th
e Galeazzi fracture.
     If the Galeazzi injury is not recognized, the 
radioulnar dislocation may not be identified.  This can 
result in a painful prominence of the distal ulna.  
Occasionally, the extensor digitorum communis tendon 
may become entrapped between the ulnar epiphysis 
and metaphysis in children, making closed reduction 
impossible.

References
     Letts RM.  Monteggia and Galeazzi Fractures.  In:
Letts RM (ed):  Management of Pediatric Fractures.  
New York, Churchill Livingstone, 1994, pp. 295-321.