title: Galeazzi fractures: Is DRUJ instability predicted by current guidelines?
abstract: BACKGROUND
  Clinically significant distal radioulnar joint (DRUJ) injuries can occur with radial shaft fractures. Several radiographic methods of diagnosis, such as radial shortening of >5mm or fracture line within 7.5cm from the lunate facet, have been proposed but not clinically validated. The purpose of this study was to compare radiographic measurements of radial shaft fractures associated with and without clinically significant DRUJ injury (i.e., true Galeazzi fracture-dislocation) in order to evaluate the predictive value of reported parameters of DRUJ injury.
  
  
  METHODS
  A retrospective record and radiographic review was performed of 66 consecutive skeletally mature patients with isolated radial shaft fractures from 2004 to 2014 treated at one level 1 academic trauma center. Intraoperatively determined DRUJ instability after radial shaft fixation was used as the gold standard for diagnosis of a Galeazzi fracture-dislocation.
  
  
  RESULTS
  Average age was 34 years old (range: 18-90). By thirds, there were 10 proximal (15%), 27 middle (41%), and 29 distal (44%) fractures. 13 (20%) had an associated ulnar styloid fracture. 7 (11%) patients had DRUJ instability after radial fixation. Radial shortening averaged 4.4±5.2mm (-2.6-22), and 21 had shortening of >5mm. Twenty-six (39%) fractures were within 7.5cm of the wrist joint. Previous guidelines were only moderately accurate. Even greater shortening did not predict instability (3/7 patients with >10mm shortening had a true injury). Four out of 7 cases with instability had ulnar styloid fractures (p=0.02).
  
  
  CONCLUSIONS
  Using a larger data set than has historically been evaluated, previously reported radiographic guidelines are only moderately accurate. The presence of an ulnar styloid fracture can be helpful. Surgeons should be aware of these associations but rely primarily on intraoperative assessment of the DRUJ after radial fixation to determine treatment.
authors.affiliation: Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States.
authors.forename: Tony
authors.initials: T
authors.lastname: Tsismenakis
authors.affiliation: Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA, United States. Electronic address: ptornetta@gmail.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Tornetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D007593:Joint Instability / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011885:Radius Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014457:Ulna / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery; D014458:Ulna Fractures / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014481:United States; D014955:Wrist Joint / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult
keywords: DRUJ; DRUJ dislocation; Galeazzi; Galeazzi fracture; Radial shaft fracture