GALEAZZI FRACTURE

&
MONTEGGIA
FRACTURE
 content
• Introduction
• Anatomy
• Definition
• Mechanism Of Injury
• Sign and symptoms
• Treatment
• Complication
• Case study
• Nursing care plan
 INTRODUCTION
GALEAZZI FRACTURE MONTEGGIA FRACTURE

• Named after Ricardo • Named after Giovanni Battista

Galeazzi (1866–1952), Monteggia (1762 – 1815)
• Italian surgeon at the Instituto de • an Italian surgeon.
Rachitici in Milan, who described
the fracture in 1934.
 PROXIMAL
OLECRANON
PROCESS

RADIUS
ULNA

STYLOID PROCESS STYLOID PROCESS

OF RADIUS OF ULNA

DISTAL
 Definition
GALEAZZI FRACTURE MONTEGGIA FRACTURE
• a fracture of the distal third of • fracture of the proximal third of
the radius with dislocation of the ulna with dislocation of the
the distal radioulnar joint proximal head of the radius.
(DRUJ). (White et al., 2016) (White et al., 2016)
 Mechanism Of Injury
GALEAZZI FRACTURE MONTEGGIA FRACTURE

• They are associated • Fall on an outstretched hand

with a fall on an with the forearm in
outstretched arm excessive pronation (hyper-
pronation injury).
• Direct blow on back of upper
forearm (Direct Trauma)
 Types of Galeazzi fracture
TYPE 1
• Apex Volar
• Cause by axial loading of
forearm in supination
• Dorsal displacement of radius
and volar dislocation of distal
ulna
TYPE 2
• Apex Dorsal
• Cause by axial loading of
forearm in pronation
• Anterior displacement of
radius and dorsal dislocation of
distal ulna
Types of MONTEGGIA FRACTURE
TYPE I TYPE II TYPE III TYPE IV

• Anterior • Posterior • Lateral • Anterior

dislocation of dislocation of dislocation of dislocation of
radial head radial head radial head radial head
with anterior with posterior with a with fractures
angulation of angulation of metaphyseal of both radius
fracture fracture ulnar fracture ulna
 Sign and symptoms
GALEAZZI FRACTURE MONTEGGIA FRACTURE
• Pain and swelling in forearm and wrist. • Swelling
• Tenderness over lower end of ulna • Limitation of elbow
• May be associated with compartment • Varus deformity of
syndrome. elbow
• Sometimes associated with wrist
drop due to injury to radial nerve,
extensor tendons or muscles.
• Anterior interosseous nerve (AIN)
palsy may also be present,
 treatment
• Non surgical : Closed reduction and cast
• Surgical : Open Reduction Internal Fixation (ORIF)
GALEAZZI FRACTURE MONTEGGIA FRACTURE
 Non surgical
• Above elbow POP ( Plaster Of Paris)
1)Care of patient on POP :
Keep the plaster dry
Don’t stick objects down the plaster ,as will
damage the skin
Keep the plastered body part raise to
prevent swelling, especially for the first 48
hours. (use arm sling)
-On average, plaster casts stay on for about
6/52 depending on callus formation.
 Surgical treatment
• Open reduction and internal fixation of radius
with reduction and stabilization of DRUJ
1)Pre op assessment
Consent, blood consent, anaest consent
Keep patient NBM as ordered by anaest
GSH per protocol
Marking site of operation site
Blood investigation ( FBC , RP )
2) Post op care
Elevated hand – reduce swelling
Circulation chart
Iv antibiotic & Iv analgesic as
ordered by doctor
Post op plan – WI D3, STO D14
 complication

Compartment syndrome – 6P
Neurovascular injury – uncommon except type III
open fracture
Non union- is permanent failure of healing
following a broken bone
Mal union –fracture bone doesn’t heel properly
DRUJ subluxation – incomplete or partial
dislocation of a joint
 Compartment syndrome – 6P
• Pain
• Pallor
• Paresthesia
• Paralysis
• Pulselessness
• Poikilothermia
 Case study
• Nama : Zarulsyah bin Tawi
• Rn : 2673156
• Umur : 34
• Date Of Admission : 16/10/2019
• Diagnosis : Closed left Galeazzi fracture with ulna
styloid involvement.
• Patient history of MVA today motorbike
skidded.
• Fall at the left side
• Complaint of pain at left forearm and wrist.
• Swollen left hand , No LOC , No ENT bleeding
• CMR was done from yellow zone. Above
elbow pop applied. Checked x-ray not
acceptable.
• Admitted to ward
• Plan for operation plating of left radius KIV
for DRUJ k-wire under elective list later.
INVESTIGATION
 PRE OP ASSESMENT
• Refer anaest for pre op assessment
• Blood investigation- FBC, RP, COAG and GSH
• Consent, blood consent
• Monitor vital sign 4 hourly
• Monitor circulation chart every 4 hour
• Listed 4th case ot7 ( plating of left radius and keep in
view distal radioulnar joint k-wiring)
 POD-POD1-2

• Monitor vital sign

• Monitor circulation chart
• Monitor dressing – no bleeding
• Refer physio for ROM ( Range of Mortion )
• Continue analgesia and antibiotic
 Pod 3-4

• Wound inspection done – wound clean.

• Dressing with saline done covered with op-site
• Checked x-ray done- acceptable
• Patient allowed discharge with oral antibiotic 5/7
and analgesic
• For STO on D14 from operation date
• TCA 6/52 with XOA
Post op xray
 Nursing care plan
Date/ Nursing diagnose Goals Nursing Intervention Evaluation
Time
16/10/1 Pain related with Pain 1. Assess patient’s pain by After 1 hour
9 fracture of left reduce using pain score ruler. Patient felt
0200H hand (Closed left (pain score 2. Elevate and rest the comfortable
Galeazzi fracture 1-3) fracture side. and pain
with ulna styloid 3. Support the fracture side reduced (pain
involvement) when moving such as score :2)
Pain score : 5 using armsling.
4. Encourage divertional
activities such as deep
breathing exercise to
diverts patient mind from
pain.
5. Administered analgesic
as prescribed by doctor..
6. Reassess pain patient
after 1 hour.
Date/ Nursing Goals Nursing Intervention Evaluatio
Time diagnose n
18/10/ Potential No sign 1.Asses sign and No sign
2019 infection related and symptoms of infection and
@ to operation site symptom such as redness, warm, symptom
1900H infection discharge at the of
seen operation site. infection
2.Monitor vital sign seen until
especially temperature , patient
inform doctor if discharge
abnormal.
3.Dressing done with
aseptic technique
4.Antibiotic given as
ordered by doctor – iv
zinacef 750mg
Date/ Nursing Goals Nursing Intervention Evaluation
Time diagnose

18/10/ Potential No sign 1.Asses wrist movement. No

2019 contracture and (flexion and extension). contracture
@ related to lack of symptom 2.Encourage physio until seen after
1900H movement contractu patient get full range of 1/52
re seen motion
3.Advise patient to do
self exercise to prevent
contracture
Additional Video
 References
• White, T. O., Mackenzie, S. P & Gray, A. J. (2016).
Orthopeadic Trauma and Emergency Fracture
Management. (3rd ed.). Poland: Elsevier.
• ORTHOfilms. (2015, May 26). Closed Reduction of a Distal
Radius Fracture [Video file]. Retrieved from
https://www.youtube.com/watch?v=cy6f7he2e4w
• Mellick, L. (2010, Feb 22). Pediatric Radius and Ulna
Fractures [Video file]. Retrieved from
https://www.youtube.com/watch?v=YD9LRRGJXL0
Thank you