A patient develops 'Galeazzi fracture dislocation' with a distal radial shaft fracture and distal radioulnar joint (DRUJ) disruption. The radiographic indicator of DRUJ instability on AP X-ray is:
- A Radial shortening > 5 mm
- B Ulnar styloid fracture at its base
- C Dorsal angulation of the distal radial fracture > 20°
- D Widening of the DRUJ space or ulnar head displacement relative to the sigmoid notch ✓
Explanation
Galeazzi fracture (fracture of distal third of radial shaft + DRUJ disruption) is treated by ORIF of the radius; if the DRUJ reduces anatomically after radius fixation, no further treatment is needed. DRUJ instability is confirmed radiographically by widening of the DRUJ joint space, subluxation or dislocation of the ulnar head from the sigmoid notch, and/or ulnar styloid fracture at its base (indicating TFCC avulsion). Radial shortening >5 mm is an indirect indicator. Persistent DRUJ instability after radius fixation requires DRUJ repair or temporary transosseous K-wire fixation. This fracture is the mirror image of Monteggia (ulnar shaft fracture + radial head dislocation).
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.