Slide 128 — Galeazzi fracture

Clean FRCS notes with inline figures

Radiographic description

•Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture

Assessment:

•Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome

Aim of management:

•Restore full rotation of forearm

•Anatomical reduction of radius and concentric reduction of DRUJ

Initial mx:

•try CR + slab

Indications for surgery:

•Failed CR SHII

•SHIII/IV (unstable)

•Triplane variant

•Galeazzi

Technique:

•CR under GA

•Percut pinning with K wire x1 from radial styloid (needs to cross physis to be stable enough)

•Check DRUJ stability

•Method one: flex elbow to 90 deg, displacement in dorsal palmar direction with forearm in neutral, pronation, supination and with wrist with radial deviation

•Method two: compress the ulnar against the radius while the forearm is passively out through supination, pronation

•→ Stable = free mobilization

•Unstable in either pronation or supination = immobilize in stable position for 4-6 weeks

•Unstable in both pronation or supination (grossly unstable)

•Bone: check radius reduction, fix ulnar styloid if large fragment

•Soft tissue: open DRUJ to make sure not soft tissue interposition, TFCC repair

•If still unstable after addressing the above = transfix distal R and U proximal to DRUJ

•Long arm cast in supination

•May need ORIF – volar approach to radius, fix with IMN / plating

•Acceptable alignment in distal radius fracture

•<10yo: <30 deg

•>10yo: <20 deg

Direct Q&A

Q1 What are the radiographic findings for Galeazzi fracture?

•Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture

Q2 What assessment points are listed for Galeazzi fracture?

•Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome

Q3 What are the management aims for Galeazzi fracture?

Restore full rotation of forearm

•Anatomical reduction of radius and concentric reduction of DRUJ

Q4 What operative steps, indications, and risks are listed for Indications for surgery?

Failed CR SHII

•SHIII/IV (unstable)

•Triplane variant

•Galeazzi

Raw speaker-note hierarchy audit

#	lvl	marL	indent	logical	original note line
1	0	None	None	0	Describe Xray:
2	0	None	None	0	Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture
3	0	None	None	0	Assessment:
4	0	None	None	0	Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome
5	0	None	None	0	Aim of management:
6	0	None	None	0	Restore full rotation of forearm
7	0	None	None	0	Anatomical reduction of radius and concentric reduction of DRUJ
8	0	None	None	0	Initial mx:
9	0	0	0	0	try CR + slab
10	0	0	0	0	Indications for surgery:
11	0	171450	-171450	1	Failed CR SHII
12	0	171450	-171450	1	SHIII/IV (unstable)
13	0	171450	-171450	1	Triplane variant
14	0	171450	-171450	1	Galeazzi
15	0	0	0	0	Technique:
16	0	171450	-171450	1	CR under GA
17	0	171450	-171450	1	Percut pinning with K wire x1 from radial styloid (needs to cross physis to be stable enough)
18	0	171450	-171450	1	Check DRUJ stability
19	1	628650	-171450	2	Method one: flex elbow to 90 deg, displacement in dorsal palmar direction with forearm in neutral, pronation, supination and with wrist with radial deviation
20	1	628650	-171450	2	Method two: compress the ulnar against the radius while the forearm is passively out through supination, pronation
21	1	457200	0	1	→ Stable = free mobilization
22	1	628650	-171450	2	Unstable in either pronation or supination = immobilize in stable position for 4-6 weeks
23	1	628650	-171450	2	Unstable in both pronation or supination (grossly unstable)
24	2	1085850	-171450	3	Bone: check radius reduction, fix ulnar styloid if large fragment
25	2	1085850	-171450	3	Soft tissue: open DRUJ to make sure not soft tissue interposition, TFCC repair
26	2	1085850	-171450	3	If still unstable after addressing the above = transfix distal R and U proximal to DRUJ
27	0	171450	-171450	1	Long arm cast in supination
28	0	171450	-171450	1	May need ORIF – volar approach to radius, fix with IMN / plating
29	0	0	0	0	=============================
30	0	0	0	0	Acceptable alignment in distal radius fracture
31	0	171450	-171450	1	<10yo: <30 deg
32	0	171450	-171450	1	>10yo: <20 deg

lvl

marL

indent

logical

original note line

None

Describe Xray:

None

Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture

None

Assessment:

None

Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome

None

Aim of management:

None

Restore full rotation of forearm

None

Anatomical reduction of radius and concentric reduction of DRUJ

None

Initial mx:

try CR + slab

Indications for surgery:

171450

-171450

Failed CR SHII

171450

-171450

SHIII/IV (unstable)

171450

-171450

Triplane variant

171450

-171450

Galeazzi

Technique:

171450

-171450

CR under GA

171450

-171450

Percut pinning with K wire x1 from radial styloid (needs to cross physis to be stable enough)

171450

-171450

Check DRUJ stability

628650

-171450

Method one: flex elbow to 90 deg, displacement in dorsal palmar direction with forearm in neutral, pronation, supination and with wrist with radial deviation

628650

-171450

Method two: compress the ulnar against the radius while the forearm is passively out through supination, pronation

457200

→ Stable = free mobilization

628650

-171450

Unstable in either pronation or supination = immobilize in stable position for 4-6 weeks

628650

-171450

Unstable in both pronation or supination (grossly unstable)

1085850

-171450

Bone: check radius reduction, fix ulnar styloid if large fragment

1085850

-171450

Soft tissue: open DRUJ to make sure not soft tissue interposition, TFCC repair

1085850

-171450

If still unstable after addressing the above = transfix distal R and U proximal to DRUJ

171450

-171450

Long arm cast in supination

171450

-171450

May need ORIF – volar approach to radius, fix with IMN / plating

=============================

Acceptable alignment in distal radius fracture

171450

-171450

<10yo: <30 deg

171450

-171450

>10yo: <20 deg

Improved semantic hierarchy used for the study notes

#	semantic level	section?	rewritten line
1	0	yes	Radiographic description
2	1		Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture
3	0	yes	Assessment:
4	1		Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome
5	0	yes	Aim of management:
6	1		Restore full rotation of forearm
7	1		Anatomical reduction of radius and concentric reduction of DRUJ
8	0	yes	Initial mx:
9	1		try CR + slab
10	0	yes	Indications for surgery:
11	1		Failed CR SHII
12	1		SHIII/IV (unstable)
13	1		Triplane variant
14	1		Galeazzi
15	0	yes	Technique:
16	1		CR under GA
17	1		Percut pinning with K wire x1 from radial styloid (needs to cross physis to be stable enough)
18	1		Check DRUJ stability
19	2		Method one: flex elbow to 90 deg, displacement in dorsal palmar direction with forearm in neutral, pronation, supination and with wrist with radial deviation
20	2		Method two: compress the ulnar against the radius while the forearm is passively out through supination, pronation
21	1		→ Stable = free mobilization
22	2		Unstable in either pronation or supination = immobilize in stable position for 4-6 weeks
23	2		Unstable in both pronation or supination (grossly unstable)
24	3		Bone: check radius reduction, fix ulnar styloid if large fragment
25	3		Soft tissue: open DRUJ to make sure not soft tissue interposition, TFCC repair
26	3		If still unstable after addressing the above = transfix distal R and U proximal to DRUJ
27	1		Long arm cast in supination
28	1		May need ORIF – volar approach to radius, fix with IMN / plating
29	0		——
30	1		Acceptable alignment in distal radius fracture
31	1		<10yo: <30 deg
32	1		>10yo: <20 deg

semantic level

section?

rewritten line

yes

Radiographic description

Displaced fracture distal shaft of radius+ greenstick fracture distal ulnar + fracture of distal ulna physis and DRUJ dislocation → Galeazzi fracture

yes

Assessment:

Age, mechanism of injury and r/o associated injury (Xray whole UL and look at PRUJ), NV injury, compartment syndrome

yes

Aim of management:

Restore full rotation of forearm

Anatomical reduction of radius and concentric reduction of DRUJ

yes

Initial mx:

try CR + slab

yes

Indications for surgery:

Failed CR SHII

SHIII/IV (unstable)

Triplane variant

Galeazzi

yes

Technique:

CR under GA

Percut pinning with K wire x1 from radial styloid (needs to cross physis to be stable enough)

Check DRUJ stability

Method one: flex elbow to 90 deg, displacement in dorsal palmar direction with forearm in neutral, pronation, supination and with wrist with radial deviation

Method two: compress the ulnar against the radius while the forearm is passively out through supination, pronation

→ Stable = free mobilization

Unstable in either pronation or supination = immobilize in stable position for 4-6 weeks

Unstable in both pronation or supination (grossly unstable)

Bone: check radius reduction, fix ulnar styloid if large fragment

Soft tissue: open DRUJ to make sure not soft tissue interposition, TFCC repair

If still unstable after addressing the above = transfix distal R and U proximal to DRUJ

Long arm cast in supination

May need ORIF – volar approach to radius, fix with IMN / plating

——

Acceptable alignment in distal radius fracture

<10yo: <30 deg

>10yo: <20 deg

128. Galeazzi fracture

Clean FRCS notes with inline figures

Radiographic description

Assessment:

Aim of management:

Initial mx:

Indications for surgery:

Technique:

Direct Q&A

Restore full rotation of forearm

Failed CR SHII

Raw speaker-note hierarchy audit

Improved semantic hierarchy used for the study notes