Year: 2026 | Month: July-September | Volume: 11 | Issue: 3 | Pages: 198-207
DOI: https://doi.org/10.52403/ijshr.20260323
Comparative Outcome of Distal Radioulnar Joint Instability in Galeazzi Fractures: Conservative Management versus K-wire Fixation
Manjeera Rednam1, Simhachalam Naidu D2, Kalyan Chakravarthy A3, V. Saran Kumar4
1,2,3Assistant Professor, 4Post-Graduate,
Department of Orthopaedics, Andhra Medical College, Visakhapatnam, India.
Corresponding Author: Dr. Manjeera Rednam
ABSTRACT
Background: The Galeazzi fracture-dislocation, a fracture of the distal radial shaft with disruption of the distal radioulnar joint (DRUJ), accounts for 3–7% of forearm fractures. Persistent DRUJ instability after radial fixation is a recognized cause of chronic wrist pain, restricted forearm rotation and reduced grip strength, yet the optimal method of managing residual instability remains controversial.
Objective: To compare the functional and clinical outcome of DRUJ instability in Galeazzi fractures managed with above-elbow plaster-of-Paris (POP) immobilization in supination versus supplementary K-wire trans-fixation of the ulna to the radius, following rigid internal fixation of the radial shaft.
Methods: This prospective comparative study was conducted in the Department of Orthopedics, Andhra Medical College, Visakhapatnam, over 14 months (October 2022 – December 2023) on 30 adult patients with Galeazzi fracture and intra-operatively confirmed DRUJ instability, all treated with open reduction and 3.5 mm dynamic compression plating of the radius. Fifteen patients were managed post-operatively with above-elbow POP casing in full supination for 4–6 weeks, and fifteen with supplementary K-wire fixation of the DRUJ (also for 4–6 weeks). Patients were followed up at 1 week, 1 month, 3 months and 6 months. Outcome measures were wrist range of motion (goniometer), grip strength (hand dynamometer) and the Gartland and Werley wrist score.
Results: No statistically significant baseline difference was found between the two groups for age, gender, side or mode of injury (p > 0.05). At 6 months, 21 of 30 patients (70%) had an excellent functional score and 9 (30%) a good score, with no fair or poor outcomes in either group. Excellent results were seen in 10/15 (66.7%) of the conservative group and 11/15 (73.3%) of the K-wire group; this difference was not statistically significant (p = 0.72). Grip strength improved progressively and significantly within both groups (mean gain 6.0 kg conservative, 5.0 kg K-wire; both p < 0.001), from a mean of 18.0 kg (conservative) and 19.5 kg (K-wire) at 1 week to 24.0 kg and 24.5 kg respectively at 6 months. Wrist flexion, extension, pronation and supination did not differ significantly between groups, with no patient in either group demonstrating a fixed loss of forearm rotation.
Conclusion: Both above-elbow POP immobilization in supination and supplementary K-wire trans-fixation appeared to be effective methods of managing DRUJ instability after rigid plate fixation of Galeazzi fractures, with no statistically significant difference between them on any outcome measure at 6 months. Given the small sample size, this absence of demonstrated difference is not proof that the two methods produce equivalent outcomes. Treatment selection needs to be individualized, guided by the degree of intra-operative instability, patient compliance and surgeon preference.
Keywords: Galeazzi fracture; distal radioulnar joint instability; K-wire fixation; conservative management; Gartland and Werley score; forearm fracture.