1982 by The Journal

Copyright

Unstable

BY
the Section

Incorporated

W.

Surgery,

Monteggia

of the Forearm

and Galeazzi

FREDERICK

of Orthopedic

Forty-nine

ABSTRACT:

Surgery.

Fracture-Dislocations

(Monteggia
From

and Join:

ofBone

RECKLING,

M.D.t,

Deoartment

and

Lesions)*

KANSAS

ofSurgery,

University

KANSAS

of Kansas

Monteggia

forty-seven

CITY,

fracture;

Medical

if the

Galeazzi
lesions
were
treated
over a twenty-five-year
period.
I used Bados
criteria23
to evaluate
the results
in the Monteggia
lesions.
In all of the children
in the

it is the distal radio-ulnar

the Galeazzi
or so-called
Reduction
of both

series

dislocations

either

closed

or open

suits,
while
the results
fractures
in the adults

reduction

of treatment
in the study

yielded

good

re-

of the Monteggia
varied.
The best re-

suits
were
obtained
in Type-I
lesions
treated
by open
anatomical
reduction,
internal
stabilization
of the
ulnar fracture,
and closed
reduction
of the radial
head.
Factors
leading
to poor results
in Type..!
lesions
were
failure
to
heterotopic

obtain
anatomical
reduction
of
ossification
including
synostosis

proximal

parts

or recurrence

of the

radius

and

of dislocation

ulna,

of the

and

radial

the

ulna,
of the

persistence
head.

In pa-

tients in whom
the radial
head could not be reduced
by
closed
methods,
the
radial
head
was
buttonholed
through
the joint capsule
and the annular
ligament
was
displaced
but not ruptured.
I have not found
that reconstruction
treatment
II, III,

of the annular
ligament
is necessary
of acute
Monteggia
fractures.
In the

and

IV lesions

rule.
The
results
Galeazzi
fractures

in this

series,

fair results

of closed
reduction
in the adults
in this

in the
Type-

were

of the forearm
obtained
good

Fracture
of either
either at the elbow

tion

in full
results.

supination

for six to

due to factors
that may not
Mistakes
in the treatment
account
for a high incidence
bone of the forearm
is frac.

tured,
the presence
of any shortening
of that bone
that there is a dislocation
of the proximal
or distal
ulnar joint.
The wrist
carefully
scrutinized
forearm.
proximal
*

When
the
radio-ulnar
Read

in part

and elbow
whenever
ulna

and
VOL.

Hospital,

64-A,

39th

is fractured
joint
dislocates,

at the Annual

Orthopaedic
Surgeons,
San
.p University
of Kansas
and

NO. 6, JULY

Rainbow

1982

joints
there

Meeting

Francisco,
Medical

means
radio-

therefore
should
be
is a fracture
of the
and

of The

shortened,
producing

American

the
the

Academy

California,
February
20, 1979.
Center,
College
of Health
Sciences

Boulevard,

Kansas

City,

Kansas

be accurate

ment on the interosseous

location
may
result

breaks

City

and

is shortened,

joint that dislocates,

producing
reverse-Monteggia
fracture.
components
of these
fracture-

healing
is complete
if good
either
of these
requirements
malalignment
of the fracture

and

must

be maintained

until

results
are to be obtained.
If
is not met there
may be
fragments
so that encroach-

space may ensue,

with
loss
either

a persistent
disof supination-

pronation
of the forearm
or of motion
of the wrist or elbow,
or both of these complications
may occur.
Because
of the similarities
in etiology
and treatment
of these
two types
of fracture-dislocations,
I reviewed
ninety-six
Monteggia
and Galeazzi
fractures
that were
treated
at the University
of Kansas
Medical
Center
over a
twenty-five-year
period
(1956 through
1980),
lar emphasis
on classification,
mechanism
treatment,
complications,
and final results.

with particuof injury,

The first sec-

tion

lesion

of this

and

the

The Monteggia
lesion
has been well documented
the literature.
In 1940 Speed
and Boyd described
their

in
ex-

second

paper

with

the

deals

with

Galeazzi

Monteggia

the Monteggia
fracture-dislocation.

66103.

of

Fracture-Dislocation

perience
with sixty-two
Monteggia
fractures,
Boyd
and Boals
reported
on 159 Monteggia
Bruce
et al. reported
on thirty-five
Monteggia
and,

more

secutive
in 1962

bone of the forearm

with a dislocaor at the wrist is not a common
in-

jury, and is inherently

unstable
be evident
to many physicians
of these fracture-dislocations
of poor
When
one

radius

Kansas

the

of the classic
series
were not

good,
due to malunion
of the radius
and persistent
derangement
of the distal
radio-ulnar
joint.
The seventeen patients
who were treated
with accurate
reduction
and internal
fixation
of the fractured
radius
and immobilization
eight weeks

must

Center,

recently,

acute
Bado2

Peir#{243}
et al. described

Monteggia
set forth

and

in 1969
fractures.
fractures

twenty-five

fractures
in children.
a system
of classification

con-

However,
based on

the mechanism
of injury,
treatment,
and results
that established
distinctions
among
four types of Monteggia
lesions
and rendered
previous
reports
somewhat
obsolete
Utiliz.

ing
Bados
classification,
Cordell
and
I reported
twenty-four
acute
Monteggia
fractures
in 1968,
but
study
included
only three
Type-Il-equivalent
lesions

on
that
and

no Type-Il-equivalent
or Type-IV
lesions7.
I am now expanding
that series17
to include
twenty-five
more
recent
acute
Monteggia
fractures
in addition
to the twenty-four
fractures

reported

previously,

with

emphasis

on the results

of treatment
of the various
types of lesions
Four fractures
that were
seen
late (three
months
or more
after
initial
treatment)
have been excluded
from the current
study.
The
length
of follow-up
ranged
from six months
to five years.
Final results
were based
on the range
of active
motion
of
.

the

wrist,

forearm,

and

elbow,

and

each

result

was

rated
857

858

F.

only

after

further

recovery

was

treatment

as those

was

thought

to be

anticipated.

of activities

of daily

living,

correlated
well with the extent
good result
was one in which
grees

of loss

of motion

in a poor

result

motion.

there

These

allow

comparisons

3 through
fracture

was

equivalent

and

Material

pain

degrees
tension

and

than

of loss

measurements

with

others.

In

than 30 desites, while

30 degrees

objective

series

or elbow.

10 but less
of the three

of

1 and

Some

years,

and

radial

obtained

when

head

of pronation
of the elbow,

was

of a fall

injury
adults

was not found

with a Type-I

in any
lesion.

charts

of five,

kind

but

the

Three
.

1)
Monteggia

lesions

in

1). In contrast
to most
rethis lesion inexplicably
occurred
than in children
in the present

who

were

treated

in our

one

had

with

a fair

the fracture
of the ulna
head had been completely

hospi-

This

yield

good

experience

three

poor

types

of fixation

two

results.

factors

timum
cal

FIG.

lesion,

be retrieved.
(Type
I) can

dislocation

or

less

forced

in the
than

series,

thirteen

four
years

were
old,

thus

of

favoring

the

All
final

in a long
and flexed
patients
solved

One

four

theory
of

the

Evans

children

result

with

plaster
more

cast with the

than 90 degrees

closed

had a posterior
within

six

additional

angulated
radial

of

nineteen
in the

specified

and

the

fracture

of

Good

head.

results
ulna

were

In five

reduction

of the

child

after

in

a history

of

fracture
of the
a torsion
force

ulna
and

hyperpronation

in the

series

and

the

initial

had a Type-I

which
sustained

to

each

conclusions

that
adult

is, closed
does
not

with

a fair

result,
than

to obtain

anatomi-

and,

of the
result,

head.
In
reduction

of

the

occurred,

radial

with

forearm

and

sub-

elbow.

one was in a patient

and anterior
dislocation

the radial head. Some authors5

a Monteggia
lesion
but rather

op-

in addi-

radial
open

reduction
of the

various
reduction

for the less

in malunion

formation

of motion

with

closed

failure

complete

bone

restriction

obtained

patients

resulted

obtain

have argued
that
a fracture-dislocation

this

who
of
is not
of the

elbow.
However,
the injury
does fulfill Bados
criteria23
(fracture
of the ulna and dislocation
of the radiohumeral
joint).
In this patient
the olecranon
was excised,
the triceps
mechanism

was
and

was

fixed

advanced,
with

removed.

and

the

tients

who

had a poor

of

other

and

a Kirschner
The

done,

at

the

accurate

subluxation
with a fair

heterotopic

re-

In

of the radial
of the three pa-

with

responsible

Of the three poor results,

a fracture
of the olecranon

wire

injury.

lesion,

but

because

obtained

result.

series;
in an

were
and

patients,

ulna

in

immobilization

palsy

required

duced

forearm
in full supination
at the elbow.
One of these

interosseous-nerve

weeks

injuries

had

of

was

had

the

had a closed

a poor

reported
fracture

In the seven

probably

head,

of the
and

acute

who

reduction

Of

fracture

two,

open reduction
and some type of
were
six good,
seven
fair,
and

of the

outcome.

sequent

head.

fracture
force as in

hyperpronation8.

hand.
The
suggesting

children.

the

from:
Unstable
Fracture-Dislocations
Galeazzi
Lesions,
by F. W. Reckling
Surg., 96: 1001,
1968.)

a fall on the outstretched

was oblique
in orientation,

good

fracture
of

I believe
that the classic
Monteggia
occur by direct trauma,
a bending

lesions

children,

of an ulnar

anterior

and

hyperextension24,

Type-I

consisting

associated

with permission
The Monteggia

a Type-I

is consistent

tion, caused
persistent
the other
two patients

Arch.

hand

results36.

of the radial

L. D. Cordell.

not

nor the dislocation

reduced
in any

Sixteen
adults
had
internal
fixation.
There

Forearm.

and exof the

patient
there was malunion
of the ulnar fracture
and persistent subluxation
of the radial
head,
resulting
in limitation
of motion
of the elbow
and forearm.
In retrospect,
neither

from essentially
all recently
reduction
of a Monteggia

(Reprinted

was

15

mechanism

a transverse

and

tients.

an

specific

of

lost

of the records
of the
A fall was mentioned

revealed

of the adults

reduction:

Type-I

children

Monteggia

had

the ulna, a comminuted

fracture,
or a fracture
with a butterfly configuration,
all of which implicate
a direct blow or
a bending
force rather than torsion
as the mechanism
of in-

have been excluded

from the study because
they
treated
as outpatients
and thus their records
could not

with

at the age

He

on an outstretched

this

of fall

always

were

A Type-I

seen

and supination
of the forearm
and had a very slight increase

tal may

anteriorly

he was
subluxated.

for the children,

roentgenograms

lesions.

twenty-three

of the

the

jury.
(Fig

were

of five

carrying
angle.
Whereas
a history
was

that

Figures

the age
thirteen

Methods

the present
series
(Fig.
ports
.7.8, 12.1 4.19.20.22.23.26
more
frequently
in adults
series.

no
such

each of the four types of Monteggia

by Bado23,
as well
as the Type-I-

Lesions

There

status,

forearm,

Type-Il-equivalent

and

Type-I

more
are

of this

7 illustrate
described

work

more than
in any one

criteria

and

evaluations

RECKLING

of limitation
of motion.
A
there was less than 10 de-

in the wrist,

a fair result
there
was
grees of loss of motion

maximum

Other

W.

radial

serious

patient

the
head

injuries

had
result

radial

wire.

head

At three
then

no

ThE

rethe

redislocated,

further

but

surgery

a poor

result.

The

were

treated

by open

other

of the ulnar
fracture.
In one,
the radial
head
been completely
reduced.
In the other
patient,
radio-ulnar
synostosis
developed
after an open
of the radial head. The
tionship
to the open

was
weeks,

was

two

pa-

reduction
had never
proximal
reduction

cause of the synostosis

and its relareduction
are unknown,
but the
JOURNAL

OF

BONE

AND

JOINT

SURGERY

UNSTABLE

additional

trauma

formation.

head

It has

cannot

of surgery
been

may

my

be reduced

have

experience

FRACTURE-DISLOCATIONS

played
that

when

Type-I-Equivalent

in its

the

Ten

radial

on opening

859

FOREARM

Lesions

of these

injuries

joint the radial head is found to have penetrated

the capsule
and the annular
ligament
is seen to be displaced
but not
ruptured.
Reduction
is easily
accomplished
by lifting
the
intact ligament
and replacing
the radial head in its anatom-

or fair

ical site.
repaired

fixation
of the ulna was carried
not removed.
In both of these

a rent in the capsule

2-B, and 2-C).

which

closed

Monteggia

lesion

with

anterior

dislocation

used

is easily

of the ulnar

in eight
in both

Internal

adults
children,

fixation

and

two

a good

of the fracture

in six

of the

adults.

In the

other

two

adults,

internal

out but the radial

head
patients
the arm was

was
im-

2-A

fracture

FIG.

fixation
of the ulna has been achieved
but reduction
to determine
ifthe radial
head was completely
and
is drawn
tangential
to the bicipital
tuberosity
and the anterior
line is drawn
tangential
to the posterior
border
of the radial
These
two lines should
encompass
the entire
capitellum.
If

and

anterior

dislocation

of the radial

head,

unsuccessfully

treated

by

reduction

tissue),

64-A,

NO.

lifting

ofthe

radial

the intact

6, JULY

1982

head,

annular

fulfilling

the

criteria

ligament,

and

replacing

2-B

of the radial head is incomplete

after closed
manipulation.
A roentgenographic
method
accurately
reduced.
On the lateral
roentgenogram
made with the arm in supination,
a line
border
of the radial
head and is extended
beyond
the distal part of the humerus.
Another
head (parallel
with the first line) and is extended
beyond
the distal part of the humerus.
they do not, as shown
here,
there is incomplete
reduction
of the radial
head.

FIG.
Complete

VOL.

obtained.

3)

reduction.

Internal
was used

the soft

was

seen
and

of the ulna and removal

of the radial
head followed
by active range of motion
within
three weeks
was the procedure

FIG.
A Type-I

In six of the adults

result

(Fig

were

children.

leaves
2-A,

methods,

THE

the

This
(Figs.

by closed

a part

OF

described

the radial

2-C

in Fig.

head

2-B.

Reduction

in its anatomical

was

site.

accomplished

The

rent

by

in the

opening

capsule

thejoint(note

was

then

the

easily

air

repaired.

in

860

F.

mobilized

in a plaster

ing of the fracture

longed

cast

for

three

of the radial

period

of

months

head.

immobilization

to allow

I think

that

contributed

W.

RECKLING

heal-

this
to

pro-

loss

of

elbow
extension,
which
was more than 30 degrees.
Each
of these
two patients
was rated
as having
a poor result.
One child had a closed
reduction
and the other required
an
open reduction
of the radial
head; both of them obtained
a
good result.

,-

A Type-Il-equivalent

a fracture

head
FIG.

A Type-I-equivalent

ulnar

shaft

mission
Monteggia

and of the head

from:
and

Arch.

Monteggia

Surg.,

Unstable

Type-Il

or neck

Lesions,

1003,

consisting

of a fracture

of the radius.

by

F.

(Reprinted
of

W.

Reckling

(Fig.

with per-

the

Forearm.

and

L. D. Cordell.

The

FIG.

(Reprinted
Forearm.

Monteggia
posterior

radial head
was fair.

Arch.

Type-il-Equivalent

Two such
occurred

was

from:
Unstable
Fracture-Dislocations
and Galeazzi
Lesions,
by F. W.
Surg. , 96: 1004,
1968.)

Lesions

lesions
were
as a result

a posterior

with
and

posterior

dislocation

angulation

of the

and

elbow,

fracture

of the

radius.

Lesions

(Fig.

6)

were

There
were three
treated
successfully

such

injuries,
by closed

all in children5.
reduction,
with

Two
a good

excised.

Type-IV

There

(Fig.

Lesions

were

six

such

7)
lesions

in this

series,

all the

re-

In

with posterior
angulation
of the proximal
part

with
permission
The Monteggia

L. D. Cordell.

which

lesion
dislocation

of the

lesion
shaft,

Five Type-Il
lesions,
all in adults
and all caused
by
automobile
accidents,
were included
in the series.
Each
was treated
with open reduction
and internal
fixation
of the

A Type-Il
fracture
and

ulnar

final result.
In the third child,
an interposed
annular
ligament prevented
closed
reduction
of the dislocated
radial
head
Rush pinning
of the fracture
of the ulna and open reduction
of the radial
head led to a good final result.

4)

ulna, and in three the fractured

all five patients
the final result

the

of the

1968.)

Lesions

or neck

Type-Ill

lesion,

Fracture-Dislocations

Galeazzi

96:

of

(Fig.

included
of direct

of
of

the

ulnar

the

radius.
of the
Reckling
and

5)

in the series,
each of
trauma
on the supi-

nated forearm.
Both patients
were treated
with excision
of
the radial
head,
closed
reduction
of the elbow
dislocation,
and Rush pinning
of the ulna. Active
range of motion
was
started
three weeks
after the repair.
A fair result
was obtamed
in each fracture.

FIG.

A Type-Ill
Monteggia
lesion
with a fracture
of the proximal
ulnar
metaphysis
and lateral
dislocation
of the radial
head.
(Reprinted
with
permission
from:
Unstable
Fracture-Dislocations
of the Forearm.
The
Monteggia
and Galeazzi
Lesions,
by F. W. Reckling
and L. D. Cordell.
Arch.
Surg.,
96: 1005,
1968.)

THE

JOURNAL

OF BONE

AND

JOINT

SURGERY

UNSTABLE

FRACTURE-DISLOCATIONS

OF

toward

THE

the

ulna#{176},the

radio-ulnarjoint

of
from

were

evaluated

FIG.

the

radius

Monteggia
and

lesion

fracture

of

the

ulnar

through

1980

as described

according

to the
and

anterior
and

dislocation

radial

of the

head

of

the

the

of

treated
fractures,
of

the

tients

automobile

accidents

the

patient

forearm

had

involving

on final

of the ulna
ulna caused

a 40-degree

patients

adults.

All

DATA

were

of both
in three
Five papoor re-

after Rush-pin
fixation.
the fracture
to unite but

lack

of

pronation

of

the

evaluation.

treated

more

ON

was found
in the
in this expanded

study
series,

Type

of these

three

and

The best results

sions
in adults
tion,

adults

who

were

fixation

fracture
in this sean optimum
result,

treated

there

solely

were

by

no good

fracture,

and

complete

reduction

of the radial
head
by closed
methods.
In the Type-Iequivalent
lesion
(fracture
of the ulna and fracture
of the
neck or head of the proximal
part of the radius),
the best
results
tion

were
of

the

obtained
ulnar

early active
adults
with
sion

by accurate

fracture,

reduction,

excision

of the

range of motion
of the forearm
a Type-lI,
Type-Il-equivalent,

obtained

a fair

result

with

were

obof
in

No.

some

internal
radial

fixa-

head,

and elbow.
or Type-tV

loss

of motion

A ND

FORTY-SE

of

VEN

Adults

Fractures

GALEAZZI

Results

Children

LESIONS

in Adultst

Good

Fair

l9i4

10

82

50

2
3
6

20
0i3
60

II

Il-equivalent
III
IV

40
7

The

Bado23

1 All

children

classification
obtained

Forty-three

classic

of

patients
and
of

equivalent
seven fair,

closed

results.

in the treatment
of Type-I
Monteggia
lewere obtained
by open anatomical
reducof the ulnar

injuries

23

reported
in l968
and
the results
of treatment

with a Monteggia
considered
to have

immobilization,

that

wrist,

Information
in the method
in the results

I-equivalent

years
Three

in the

of the

forty
ries,
reduction

results

Poor

Monteggia*

mature

and

of

Fracture

of the Monteggia
fractures
in children
were
invariably
good
after closed
reduction,
and only two exceptions
required
open reduction
of the dislocated
radial
head. Of the
adult
patients
only nine were

final
lesions;

recently.

M ONTEGGIA

FORTY-NINE.

Galeazzi
Galeazzi-equivalent

Discussion

As
confirmed

I). The

of motion

Twenty-three

Uni-

twenty-five

shafts.

with open reduction

and internal
fixation
while the radial head was reduced
closed
patients
and was excised
in the other three.
had a fair result,
and the one patient
with a

suIt had a non-union

Bone-grafting
of the

distal

at the

the

Monteggia

range

TABLE
sult

of the

treated

over

(Table

for

active

elbow.

were

Center

included
in the series
reported
in 1968.
tamed
from that study
led to changes
management,
with marked
improvement

with

influence

lesions

Medical

1956

forearm,

A Type-lV

Galeazzi

Kansas

years
is,

stabilizing

is lost38.

Forty-seven
versity

861

FOREARM

400
34
was

a good

these

between

forty
were
the adults

19

injuries

occurred

the ages

of fifteen

in

7
3

14

result.

in skeletally
and

sixty-nine

classic
Galeazzi
fractures
and
four
children
had

lesion.
patients

5
2

used.
final

fractures
(Fig.
9). There
and fourteen
poor results

Galeazzi
Seventeen

8
3

6
3

the

(Fig.
8).
Galeazzi-

were nineteen
in the patients

series

were

good,
with a

treated

with

immediate
open
reduction
of the fracture
of the radius,
plate-and-screw
fixation,
and immobilization
for six to
eight weeks
in a long plaster
cast with the forearm
in supination.
All patients
who were treated
in this manner
had a

and

good
result,
forearm,
and

The
le-

tal radio-ulnar
joint.
All of these
preinjury
level of activity.
Eleven

of the

with
elbow

of the

a full range
of
and no symptoms

forty

patients

motion
of
referable

patients

the wrist,
to the dis-

returned

with

a classic

of the

radial

to their
Galeazzi

elbow
and forearm,
but generally
returned
to their preinjury activities
and work and did not require
secondary
operations.
The three Type-Il!
lesions
in the series were all in
children,
and all obtained
a good result.
Galeazzi

Fracture-Dislocation

Fractures
of the shaft of the
dislocation
of the distal radio-ulnar

radius
joint

and

are

that

are

unstable9182.

unstable

brachioradialis,
thumb,

VOL.

NO.

same
In

pronator

which

64-A,

in the

tend

to

6, JULY

1982

way

addition

to

quadratus,
shorten

complicated
by
are rare injuries
Monteggia

lesions

the

of

and
the

radius

forces

extensors
and

the

of the
rotate

FIG.
The

it

Galeazzi

lesion,

which

cation
of the distal
radio-ulnar
Unstable
Fracture-Dislocations
Galeazzi
Lesions,
by F. W.
96: 1006,
1968.)

is a fracture

shaft

and

joint.
(Reprinted
with permission
of the Forearm.
The
Monteggia
Reckling
and L. D. Cordell.
Arch.

a dislo-

from:
and
Surg.,

862

F.

W.

RECKLING

FIG.

The Galeazzi-equivalent
a fracture
of the distal

fracture

were

lesion,
which
consists
of a fracture
of the radius
two centimeters
of the ulna in older
patients.

treated

immobilization.

with

Four

closed

had

reduction

a fair

and

and plaster-cast

seven,

a poor

9
in association

sor

result.

with

tendons

a separation

were

accomplished

of the distal

released.

and

was

ulnar

epiphysis

Reduction
maintained

in children

was
with

then

or

readily

plaster-cast

im-

All of these patients

had restriction
of pronation
nation
due to malunion
of the radial
fracture,

and supiand all had

mobilization.
Three

some

radio-ulnar

(a fracture
of the radius
six to eight centimeters
proximal
to the wrist joint with an additional
fracture
of the distal
two centimeters
of the ulna)
The average
age of these pa-

deformity

and

discomfort

in

the

distal

joint.
In four patients,
the Galeazzi
fracture
was treated
by
insertion
of Kirschner
wires into the radius and ulna, proximal and distal
to the fracture.
When
the wires
were removed,

the

sidered

to have

reduction

was

a poor

lost.

result

All

four

because

patients

the forearm
due to malunion
of the radius
pain and deformity
at the distal
radio-ulnar
these
of

patients

the

the

underwent

distal

distal

part

secondary

of the

radio-ulnar

ulna,
pain

did

con-

rotation

of

and persistent
joint.
Two of

resection

which
and

were

of limited

adult

patients

had

alleviate
but

ter cast.
final

All

result

three

years
One patient
the other
two had
and immobilization

patients

(Table

was treated
by
open reduction
in a long plas-

were

considered

to have

a fair

I).
Discussion

some

of

not

in-

did

lesion

tients was seventy-three

closed
reduction,
while
and plating
of the radius

of a portion

deformity

a Galeazzi-equivalent

Galeazzi
reasons.

fractures

Hughston

are inherently
believed

that

unstable
several

for several

factors

operate,

mainly
during
the period
of immobilization
One factor
is
Four
patients
were
treated
by open
reduction
and
the brachioradialis
which,
because
of its insertion
into the
screw
fixation
of the oblique
radial
fracture,
followed
by
radial
styloid
process,
tends
to shorten
the radius,
while
the pronator
quadratus
rotates
the distal
fragment
toward
plaster-cast
immobilization.
Two
patients
obtained
a good
result
with
this method,
but in the other
two the fixation
the ulna. Another
factor
is the weight
of the hand,
which
was not maintained,
the reduction
was lost,
and the result
acts as a strong
volar force displacing
or pulling
the distal
was poor
because
of loss of pronation
and supination.
fragment
of the radius
while the force of the thumb
abducTwo patients
with an open Galeazzi
fracture
had d#{233}-tors and extensors
tends
to shorten
the radial
side of the
crease

the

range

bridement

and

healed,
out.

of rotation

external

subsequent
The

some

motion

was

of

was

and

rotation

of

the

prior

When

the

in each

forearm.

This

and

had
with

limitation

treatment

grafting

wrist
that

carried

patient,

to prolonged

to plating

wound
were

fair

to be due

device

bone-grafting

considered

thought

the fixation

forearm.

fixation.

plating

result

loss

of the

of

with

of the frac-

with

Whereas

Lesions

all

seen in skeletally
ture of the radius
wrist,
associated
epiphysis.
the

end

of

equivalent

was

distal

ulnar

the
and

fourth,

the

so the

fracture

Galeazzi

radio-ulnar

epiphysis

radius.
lesion.

easy

classic

fractures

were

mature
patients,
four children
had a fracsix to eight centimeters
proximal
to the
with
separation
of the distal
ulnar

The

because

of the

radial

three

of

was

is
these

by
could

opened

was
attached

injury

maintained
fracture

site

remained

This
In

was

joint

called

not

be
the

disrupted

to the

patients,

a plaster

and

not

distal

Galeazzireduction

cast.

In the

reduced

closed,

entrapped

exten-

factors

the

radial

of the Galeazzi
Miki#{233},who

collateral

are at work

and

that

ligaments
they

emphasized

that

A complete
involves

explain

fracture-dislocation.
the disruption

I agree
the in-

I also

tal radio-ulnar
joint
is a major
factor
instability
of the Galeazzi
fracture.
always

Equivalent

relaxing

stability

ture.
Galeazzi-

by
these

agree

of the dis-

contributing

to the

dislocation
of the distal radio-ulnar
joint
rupture
of the articular
disc and of the as-

sociated
dorsal and volar distal radio-ulnar
ligaments.
This
articular
injury,
as well as the fracture
of the radius,
must
be dealt with if good results
are to be obtained
in the treatment of Galeazzi
fractures.
Anatomical
reduction
and osteosynthesis
reduction

of the

radius

of the distal

subject
have
the
injuries
18.25
Hughston

alone

radio-ulnar

does

not

joint.

guarantee
All

studies

stable
on the

cited the poor results

that are obtained
when
are
treated
by closed
methods#{176}37
suggested
immediate
resection
of the distal

part of the ulna,

and

Miki

advocated

of the distal
radio-ulnar
joint
with one
wires after fixation
of the radial
fracture.
THE

JOURNAL

OF BONE

temporary

fixation

or two Kirschner
I do not believe
AND

JOINT

SURGERY

UNSTABLE

that

either

good

of

results

duction,

these
have

procedures
been

internal

mobilization
of the
sition,
the dislocation

is necessary

obtained

fixation

FRACTURE-DISLOCATIONS

by

of the

radial

forearm
in full
of the distal

Uniformly

open

only

anatomical

in twenty-three

acute

fractures

among

the

recently

which

there

was

In that pojoint is re-

porary

external

Galeazzi

that

were

treated

not

patients

severe

soft-tissue

fixation

to allow

treated
were

in this
two

damage

way

injuries

requiring

for soft-tissue

in
tem-

repair

and

healing.
The reason
that there were no classic
Galeazzi
fractures in children
or the very elderly
in this series
may be
that in children
the epiphyseal
plate is weaker
than the articular
disc, while in osteoporotic
elderly
patients
the bone

results

Galeazzi

863

FOREARM

im-

and

duced
and the torn articular
disc and associated
ligaments
are approximated.
Immobilization
should
be continued
for
six to eight weeks
Because
of the experience
with the less
satisfactory

THE

re-

fracture,

supination.
radio-ulnar

OF

frac-

tures reported
in 1968 the policy
was adopted
of treating
all Galeazzi
fractures
in adults
in this manner.
Since then I
have had good results
in fifteen
consecutive
patients
The
,

is weaker
than
Galeazzi-equivalent
children

but

the

only

disc and associated

lesions,
good results
fair

results

were

ligaments.
In the
were obtained
in

seen

in adults.

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