Open reduction and internal fixation of the Galeazzi fracture-dislocation — distal-third radial shaft fracture with DRUJ disruption · intermediate
- The 'fracture of necessity' — in adults nearly all Galeazzi fractures require ORIF. Non-operative management yields unacceptable rates of malunion, DRUJ instability and poor outcome (Mikic, 1975: 92% poor results with plaster versus 92% good-to-excellent with ORIF).
- The DRUJ may reduce spontaneously when the radius is restored to anatomic length and rotation, but stability MUST be tested through full pronation-supination after plating. A reduced DRUJ is not necessarily a stable one.
- The prognostic distance: fractures within 7.5 cm of the midcarpal (radiocarpal) joint — equivalently within about 5 cm of the distal radial articular surface — have the highest rate of DRUJ disruption and are least likely to be stable after radius fixation alone (Rettig and Raskin Type I).
- The volar Henry approach is the standard. The interval lies between brachioradialis (radial nerve, radial artery) and flexor carpi radialis (median nerve). The radial artery is the key danger distally; the posterior interosseous nerve (PIN) is at risk proximally within the supinator.
When & Why
The injury. A Galeazzi fracture-dislocation is a fracture of the radial shaft (classically the distal third) with disruption of the distal radioulnar joint (DRUJ). The radial fracture is the obvious injury; the DRUJ disruption is the hidden one — and it is the part that decides outcome. In adults this is the fracture of necessity: nearly all require ORIF. Indication for surgery. An acute Galeazzi fracture-dislocation in an adult. Non-operative treatment fails because the brachioradialis and pronator quadratus shorten and malrotate the distal fragment, radial length cannot be held in plaster, and persistent shortening greater than 2 mm produces ulnar impaction, DRUJ incongruity and pain. Mikic (1975) reported 92% poor results with plaster immobilisation versus 92% good-to-excellent with ORIF — the study that established surgery as the standard.
- Non-operative
- 60–70% (with late displacement)
- ORIF
- greater than 95%
- Non-operative
- up to 50%
- ORIF
- 5–10%
- Non-operative
- 30–50%
- ORIF
- less than 5%
- Non-operative
- 60–80% of contralateral
- ORIF
- 85–95% of contralateral
- Non-operative
- 40–60% good-excellent
- ORIF
- 85–95% good-excellent
- Non-operative
- delayed (prolonged casting)
- ORIF
- mean 10–14 weeks
Relative indications include a displaced distal radial shaft fracture with radiographic evidence of DRUJ disruption (ulnar styloid base fracture, ulnar positive variance greater than 2 mm, ulnar head dislocation on the lateral view), and failed closed reduction in a child approaching skeletal maturity. Contraindications. Absolute: active infection over the surgical site, or a medically unstable patient who cannot tolerate anaesthesia. Relative: a minimally displaced distal radial shaft fracture with a clearly stable DRUJ on examination under anaesthesia (rare, only in lower-demand patients), or severe osteopenia precluding plate fixation (consider external fixation or non-operative management with informed consent). Timing. Primary ORIF within 24–48 hours for closed injuries; open fractures need emergency debridement and stabilisation. Reconstruction delayed beyond 3 weeks means a harder reduction, more complications and less predictable DRUJ outcomes. Special situations in whom the plan changes.
A both-bone forearm fracture that also involves DRUJ disruption (about 5–10% of both-bone fractures). The ulnar fracture distracts attention from the DRUJ, which is frequently missed. Examine the DRUJ in every forearm fracture, fix both bones, then reassess the DRUJ exactly as for a standard Galeazzi.
Screw purchase is poor. Use a 3.5 mm locking plate (angular stability), a longer plate (8–10 holes) to spread load, bicortical screws, avoid over-compression, and add a supplemental cast for 4 weeks.
Soft-tissue contracture and early callus make reduction harder; the DRUJ may be chronically dislocated. Plan an extensile exposure, resect callus, and the DRUJ may need open reduction with capsular release and TFCC repair within 6 weeks. Outcome is less predictable.
Consent specifically for radial artery injury (less than 1%), PIN neurapraxia (1–3%), superficial radial nerve dysaesthesia (2–5%), infection (less than 1%), compartment syndrome (rare), nonunion (1–3%), malunion (less than 5%), persistent DRUJ instability (5–10%), stiffness, and the possible need for K-wire transfixion or secondary DRUJ surgery. Setup. Supine, arm abducted 90 degrees on a hand table, upper-arm tourniquet (250–300 mmHg) after exsanguination — many distal-third cases can be done without a tourniquet. Position a C-arm from the contralateral side perpendicular to the table; confirm good AP and lateral views of the distal radius and DRUJ before draping. Drape the hand and forearm free so you can pronate-supinate to assess the DRUJ. General or regional (supraclavicular/infraclavicular) anaesthesia; muscle relaxation aids reduction.
The Operation
The goal is to expose the radial shaft through the volar Henry approach, restore anatomic length, rotation and bow, plate the fracture, and then — the step that decides outcome — assess and stabilise the DRUJ. The exposure defines the operation, so it is laid out in full as the first steps below. The Henry interval. The approach works the plane between brachioradialis (radially — radial nerve, radial artery) and flexor carpi radialis (ulnarly — median nerve). The radial artery lying between these two tendons is the landmark that confirms the correct plane; retract it radially with brachioradialis. The danger changes along the length of the incision.
- Critical structure
- Radial artery applied to the volar radius; superficial radial nerve emerging 8–10 cm proximal to the styloid
- How it is protected
- Identify the artery between BR and FCR before opening deep fascia; retract radially with BR; identify the SRN in the subcutaneous plane before placing retractors
- Critical structure
- Median nerve and branches deep and ulnar; FPL and pronator teres on the bone
- How it is protected
- The artery moves off bone; stay subperiosteal on the radius; protect the median nerve from prolonged retraction
- Critical structure
- Posterior interosseous nerve within the supinator; recurrent radial artery (leash of Henry)
- How it is protected
- SUPINATE the forearm to move the PIN posteriorly; elevate the supinator subperiosteally — never dissect inside the muscle belly; no dorsal retractors around the proximal radius
Operative sequence
- Supine, hand table, upper-arm tourniquet, C-arm from the contralateral side; drape the hand free for rotational assessment.
- Palpate the radial styloid and lateral epicondyle. Before tourniquet inflation, mark the radial artery pulse at the wrist and the FCR tendon (ulnar to the artery at the wrist crease).
- A longitudinal incision centred on the fracture: for a distal-third Galeazzi it begins 3–4 cm proximal to the wrist crease over FCR and runs 10–12 cm proximally along the radial border, gently curved to lie over the artery distally. Make it long enough to expose the whole fracture plus one plate length each way — inadequate exposure is a common cause of poor reduction.
- Deepen through subcutaneous fat; identify the superficial radial nerve as it emerges from beneath brachioradialis in the distal forearm and protect it — neurapraxia from a self-retaining retractor is a classic pitfall.
- Incise the deep fascia over FCR and develop the interval between FCR (ulnar) and brachioradialis (radial). The radial artery and its venae comitantes lie in this interval — the paired veins are often easier to see than the artery itself. Confirm the artery, then retract it radially WITH brachioradialis.
- Retract the artery and brachioradialis radially, and FCR/FDS ulnarly. The flexor pollicis longus is seen on the volar radius.
- For the middle and distal thirds: elevate FPL and pronator quadratus subperiosteally from radial to ulnar as a single sheet — this preserves a robust layer to close over the plate later.
- For the proximal third: supinate the forearm to swing the PIN posteriorly, then elevate the supinator subperiosteally off the radius. Never dissect into the supinator belly (the PIN runs between its two heads) and never place a retractor around the dorsal proximal radius. Ligate the recurrent radial artery (leash of Henry) as needed.
- Clear the haematoma and assess the fracture geometry (transverse, oblique, spiral, comminuted) to plan reduction and plate strategy.
- For a simple pattern, manipulate both fragments with bone-holding forceps; distract with a small distracter or manual traction to overcome the deforming forces of pronator quadratus (distal) and pronator teres/brachioradialis (proximal).
- Length: confirm by fluoroscopic ulnar variance versus the contralateral wrist — the injured side should be within 1 mm of normal. Greater than 2 mm positive variance means the radius is still short.
- Rotation: the distal fragment pronates relative to the proximal; check the cortical thickness match at the fracture site — equal thickness on both sides confirms correct rotation.
- Bow: restore the gentle lateral radial bow. Hold the reduction with a clamp or oblique K-wires and confirm on AP and lateral before plating.
- A 3.5 mm LC-DCP or LCP is standard; a locking plate is preferred in comminuted or osteoporotic bone (angular stability, less reliance on precise contouring). Use a plate long enough for at least three bicortical screws (six cortices) each side of the fracture; a very distal fracture may need a distal radius L- or T-plate.
- Contour the plate to the volar radial bow (concave volarly proximally, convex volarly distally). Sit it on the flat volar surface, slightly radial to midline to avoid the FPL tendon.
- For a simple transverse fracture, load the first screw eccentrically in the dynamic compression slot to compress; fill the rest in neutral. For a comminuted fracture, bridge the zone with no screw in the comminution (relative stability).
- Final fluoroscopy: plate position, screw length, fracture reduction and ulnar variance on the AP that includes the DRUJ. Aim screws laterally, not medially, so they do not penetrate the sigmoid notch.
Do not close until the DRUJ is formally assessed. With the radius stabilised, grasp the ulnar head, translate it volarly and dorsally versus the contralateral side, and stress it through full pronation-supination (the DRUJ is most unstable in pronation, most stable in supination). Confirm on fluoro that the ulnar head is centred in the sigmoid notch and that variance is within 1 mm. Three possible outcomes: - A — Reduced AND stable through full ROM (about 40–50% of cases). Restored radial length tensions the interosseous membrane and stabilises the DRUJ indirectly. No further surgery — below-elbow cast or splint in neutral for 6 weeks.
- B — Reducible BUT unstable. The head seats in supination but subluxates with stress. Transfix the DRUJ with two 1.6 mm K-wires from the ulnar side across into the radius with the forearm in full supination (position of maximum stability). Above-elbow cast in supination for 6–8 weeks; remove wires at 6–8 weeks.
- C — Irreducible. The head cannot be seated — interposed soft tissue, most often the ECU tendon, the dorsal capsule or a torn TFCC fragment. Open the DRUJ through a separate dorsal incision, relieve the interposition, reduce and pin as above; repair a large peripheral TFCC tear if present (rarely needed acutely). Above-elbow cast in supination for 8 weeks.
- Irrigate; release the tourniquet and achieve haemostasis.
- Re-approximate pronator quadratus and FPL over the plate if it can be done without tension — a muscle bed between plate and flexor tendons reduces irritation. Close the deep fascia loosely (do not close under tension — compartment risk), the subcutaneous layer, then skin.
- Dressing: if the DRUJ was pinned, an above-elbow backslab in supination; if stable, a below-elbow backslab in neutral.
- Radial length: ulnar variance within 1 mm of contralateral.
- Rotation: cortical match at the fracture site.
- Plate and screws: plate flat; no screw in the radiocarpal joint or the sigmoid notch.
- DRUJ: stable through full pronation-supination.
- Document radial, median and ulnar nerve function; check the forearm compartments are soft; keep tourniquet time under 2 hours.
Radial artery (distal third) — identify it between brachioradialis and FCR before opening the deep fascia and retract it radially with brachioradialis; keep the blade on bone. Posterior interosseous nerve (proximal third) — supinate the forearm to move it posteriorly, stay subperiosteal, never dissect inside the supinator and never place a retractor around the dorsal proximal radius. Superficial radial nerve — find it in the subcutaneous plane before any deep retractor goes in, and retract intermittently.
The single most important intra-operative measurement is ulnar variance. Compare the injured side to the contralateral forearm on fluoro; if the ulnar head is more than 2 mm positive versus normal, the radius is still short — do not plate until the variance is within 1 mm. Radial shortening is the commonest cause of a poor DRUJ outcome.
First — fix the radius beautifully and forget to reassess the DRUJ. Second — accept an imperfect reduction, thinking it is close enough; torsional malunion is common with standard plating, and any shortening greater than 2 mm leaves the DRUJ unstable. A reduced DRUJ on static fluoro is not necessarily a stable one — stress it clinically.
Aftercare & Complications
Rehabilitation depends on what the DRUJ needed. | DRUJ status | Immobilisation | Motion | Strengthening | |-------------|----------------|--------|---------------| | Stable | Below-elbow cast/removable splint, neutral, 6 weeks | Finger and elbow from day 1; wrist and forearm rotation from 6 weeks | From 8–10 weeks | | Pinned (reducible-unstable) | Above-elbow cast in supination 6–8 weeks | Finger, elbow and shoulder from day 1; NO pronation-supination until wires out | Forearm rotation after K-wire removal at 6–8 weeks; strengthening from 10–12 weeks | | Phase | Timing | Activity | |-------|--------|----------| | 1 Immobilisation | 0–6 weeks | Active finger motion hourly; elbow/shoulder ROM; oedema control; wound care | | 2 Early motion | 6–8 weeks | Active wrist flexion-extension and pronation-supination; passive stretching; scar management | | 3 Strengthening | 8–12 weeks | Putty and light weights (1–2 kg); proprioception; grip | | 4 Return to function | 12 weeks + | Progressive resistance and sport-specific training once union and greater than 80% contralateral strength | Return to activity. Office work 2–4 weeks; light manual work 8–12 weeks; driving 4–6 weeks (longer if immobilised above elbow); heavy manual work and sport 12–16 weeks once radiographic union is confirmed; contact sports 16–20 weeks. Hardware removal is not routine. Consider it at 12–18 months (after union and remodelling) for a symptomatic or prominent plate, tendon irritation, a very distal plate impinging on the DRUJ, or on request in a young high-demand patient. Complications
- Incidence
- 5–10% (commonest complication)
- Recognition
- Ulnar wrist pain, clicking, grip weakness, reduced rotation, positive stress test; ulnar positive variance and DRUJ incongruity on the lateral
- Prevention and management
- Systematic DRUJ assessment after every radial fixation; if early and reducible, closed reduction and K-wire transfixion; chronic — CT, then reconstruction (capsular plication, Adams-Berger tenodesis, ulnar shortening) or salvage (Darrach, Sauve-Kapandji, ulnar head replacement)
- Incidence
- less than 5% with ORIF
- Recognition
- Ulnar positive variance greater than 2 mm; ulnar wrist pain and lost rotation; rotation confirmed on CT versus contralateral
- Prevention and management
- Intra-operative contralateral comparison and cortical match; adequate plate length. Corrective osteotomy with bone graft; ulnar shortening if no DRUJ arthritis
- Incidence
- 1–3%
- Recognition
- Pain at the fracture site at 6 months; no bridging callus, visible fracture line, implant loosening
- Prevention and management
- Anatomic compression or bridge plating; preserve soft-tissue attachments; adequate plate length. Exchange plating with bone graft; rule out infection
- Incidence
- 1–3% (proximal Henry)
- Recognition
- Loss of finger/thumb MCP extension with intact wrist extension and sensation — presents in recovery
- Prevention and management
- Supinate for proximal dissection; stay subperiosteal; no dorsal retractors. Nearly all resolve in 6–12 weeks; wrist-extension splint; explore if no recovery by 6 months
- Incidence
- 2–5%
- Recognition
- Numbness or burning over the dorsoradial hand; Tinel over the emergence point
- Prevention and management
- Identify the SRN subcutaneously before deep dissection; intermittent retraction; no self-retaining retractor on the radial side. Most resolve in 3–6 months; desensitisation, gabapentin if needed
- Incidence
- less than 1%
- Recognition
- Arterial bleeding on exposure; cold hand or ischaemia post-op
- Prevention and management
- Identify the artery before the deep fascia is opened; retract with BR. Primary microvascular repair if divided; ligate only if an Allen test confirms ulnar supply
- Incidence
- rare (high-energy)
- Recognition
- Pain out of proportion, pain on passive finger stretch, tense compartments, paraesthesiae; pulse is a late sign
- Prevention and management
- High index in high-energy injuries; do not close fascia under tension; avoid tight dressings. Emergency forearm fasciotomy (volar and dorsal)
- Incidence
- 10–20%
- Recognition
- Reduced pronation-supination at 3–6 months; terminal pronation most often lost
- Prevention and management
- Early motion if DRUJ stable; rotation after K-wire removal. Therapy and static-progressive splinting; CT to exclude malunion; release if refractory at 6 months
Viva & Exam Focus
GALEAZZIGALEAZZI — the management sequence
Galeazzi — radius fracture plus DRUJ (think G, the radius Goes away from the ulna). Monteggia — proximal ulna fracture plus radial head dislocation. Opposite injuries, opposite treatments: Galeazzi fixes the radius and manages the DRUJ; Monteggia fixes the ulna and reduces the radial head.
Risk after high-energy Galeazzi injuries. Pain on passive finger stretch, tense swollen compartments and paraesthesiae are early; pulse is a late finding. Pressures greater than 30 mmHg, or within 30 mmHg of diastolic, mean urgent forearm fasciotomy.
The thick periosteum may hold the DRUJ reduced, the disruption is often a distal ulnar Salter-Harris injury rather than a TFCC tear, and many children under 12 (less than 10 degrees angulation, less than 50% displacement) can be managed closed; the surgical threshold rises as skeletal maturity approaches.
Clinical Decision Scenarios
Practise clinical reasoning and management decisions out loud
“A 32-year-old man sustains a closed Galeazzi fracture of the right forearm after a fall from scaffolding. You have ORIF'd the radial shaft through a volar Henry approach with a 3.5 mm LC-DCP and the reduction looks anatomic on fluoroscopy. Talk me through your assessment of the DRUJ and the management options depending on what you find.”
“Describe the volar Henry approach to the radius. What are the key danger zones at each level, and how do you protect the posterior interosseous nerve during proximal exposure?”
“A 28-year-old woman presents 10 weeks after ORIF of a Galeazzi fracture performed elsewhere. The radius was plated through a volar Henry approach and the operative report notes the DRUJ was reduced and stable. She now complains of persistent ulnar-sided wrist pain, a clunk with forearm rotation, and grip weakness. Her ulnar variance is plus 4 mm on the injured side versus plus 1 mm contralateral, and the DRUJ is subluxated dorsally on stress views. How do you manage this patient?”
Diagnosis
- Galeazzi = radial shaft fracture (usually distal third) plus DRUJ disruption — the DRUJ is the hidden injury
- The fracture of necessity: in adults non-operative treatment fails in greater than 80%
- Rettig and Raskin: Type I less than 7.5 cm from midcarpal joint (high DRUJ disruption); Type II greater than 7.5 cm (lower risk)
- Radiographic signs of DRUJ disruption: ulnar styloid base fracture (60–70%), ulnar positive variance greater than 2 mm, ulnar head dislocation on lateral, DRUJ space asymmetry
- Examine the DRUJ in EVERY forearm fracture, including both-bone (Galeazzi-equivalent)
Approach — volar Henry
- Interval: brachioradialis (radial nerve, radial artery) and FCR (median nerve); the radial artery confirms the plane
- Distal third danger: radial artery on bone — retract radially with BR; protect superficial radial nerve subcutaneously
- Proximal third danger: PIN within supinator — SUPINATE, stay subperiosteal, never dissect in the muscle belly
- Recurrent radial artery (leash of Henry) crosses proximally — ligate as needed
- Elevate pronator quadratus and FPL as one sheet from radial to ulnar; repair over the plate
Technique — key steps
- Mark the radial artery and FCR before tourniquet inflation; longitudinal incision centred on the fracture
- Identify the radial artery between BR and FCR; retract radially with BR
- Elevate FPL and pronator quadratus subperiosteally
- Reduce: LENGTH (variance within 1 mm of contralateral), ROTATION (cortical match), BOW (contour the plate)
- Plate with 3.5 mm LC-DCP or LCP — minimum 3 bicortical screws each side
DRUJ assessment and management
- A — Reduced and stable through full ROM: below-elbow cast neutral for 6 weeks (40–50% of cases)
- B — Reducible but unstable: two 1.6 mm K-wires across the DRUJ in SUPINATION; above-elbow cast 6–8 weeks
- C — Irreducible: open the DRUJ — most often ECU tendon or capsule interposed; reduce and pin
- K-wires out at 6–8 weeks; begin forearm rotation after pin removal
- The commonest error: fix the radius, forget the DRUJ
Complications
- Missed or persistent DRUJ instability (5–10%) — commonest; prevent by systematic assessment
- Radial malunion (less than 5%) — corrective osteotomy plus DRUJ reconstruction
- Nonunion (1–3%) — exchange plating plus bone graft
- PIN neurapraxia (1–3% proximal Henry) — resolves in 6–12 weeks
- Superficial radial nerve dysaesthesia (2–5%) and radial artery injury (less than 1%)
Aftercare
- DRUJ stable: below-elbow cast/removable splint 6 weeks; finger and elbow motion from day 1
- DRUJ pinned: above-elbow cast in supination 6–8 weeks; finger and elbow motion from day 1
- After cast removal: active wrist and forearm ROM; progressive strengthening from 8–12 weeks
- Return to heavy manual work 12–16 weeks once union is confirmed
- Hardware removal: not routine; consider at 12–18 months if symptomatic
Exam traps
- Galeazzi vs Monteggia: radius plus DRUJ versus ulna plus radial head
- A DRUJ reduced on static fluoro may be dynamically unstable — always stress it clinically
- Ulnar styloid base fracture marks TFCC disruption, but its absence does NOT exclude instability
- Comparison with the contralateral wrist is essential — mild DRUJ laxity may be constitutional
- Paediatric Galeazzi: lower surgical threshold; under 12 with acceptable alignment may be managed closed
Background & Evidence
Definition and epidemiology. A Galeazzi fracture-dislocation is a radial shaft fracture with disruption of the DRUJ, classically of the distal third. Credited to Galeazzi (1934) and earlier to Cooper, it accounts for roughly 3–7% of adult forearm fractures and is most common in young adults after a fall or direct blow, with no side predilection. The eponym is sometimes reserved for the distal-third pattern, but any radial shaft fracture with DRUJ disruption obeys the same rules. Why the DRUJ is the hidden injury. The DRUJ is stabilised by the triangular fibrocartilage complex (TFCC) — the articular disc, the dorsal and volar radioulnar ligaments, the ECU subsheath, the ulnocarpal ligaments and the meniscus homologue — and by the interosseous membrane, whose central band provides 40–60% of longitudinal stability and is tensioned when radial length is restored. The dorsal radioulnar ligament tightens in pronation and the volar in supination. A displaced ulnar styloid base fracture (present in 60–70% of Galeazzi fractures) marks TFCC avulsion, but its absence does not exclude instability. The shallow sigmoid notch (about 60–90 degrees of arc) gives little bony constraint, so soft-tissue integrity is everything. Classification that changes management — Rettig and Raskin (2001). The distance of the radial fracture from the joint predicts DRUJ disruption.
- Distance from midcarpal joint
- less than 7.5 cm
- DRUJ disruption
- High rate of DRUJ disruption; least likely to be stable after radius fixation alone
- Management
- ORIF with mandatory DRUJ assessment
- Distance from midcarpal joint
- greater than 7.5 cm
- DRUJ disruption
- Lower rate of DRUJ disruption; some stable after fixation
- Management
- ORIF if displaced or DRUJ unstable; reassess the DRUJ in every case
Plate choice. The 3.5 mm LC-DCP is the historical gold standard and demands precise contouring to the volar radial bow; the 3.5 mm LCP (locking) gives angular stability in osteoporotic or comminuted bone with less contouring. Dual plating is rarely needed except for very distal fractures where a single plate lacks distal purchase; bridge plating suits comminuted segmental patterns where absolute stability is not achievable. Key evidence. Mikic (1975) established the standard — 92% poor results with plaster versus 92% good-to-excellent with ORIF. Moore (1985) showed 30 of 33 (91%) good-to-excellent results with plating, with every poor result tracing to an inadequately treated DRUJ. Rettig and Raskin (2001) defined the 7.5 cm prognostic threshold. Schneiderman (1993) showed the interosseous membrane central band is the primary check against radial shortening — the biomechanical reason that restoring length stabilises the DRUJ.
References
Galeazzi fracture-dislocations
Classic series of 125 Galeazzi fracture-dislocations that established the injury pattern and its natural history: 92% poor results with plaster immobilisation versus 92% good-to-excellent with ORIF, and the principle that radial length and DRUJ congruence must be restored anatomically. The study that made ORIF the standard in adults.
Results of compression-plating of closed Galeazzi fractures
33 closed Galeazzi fractures treated with compression plating; 30 of 33 (91%) good-to-excellent at a minimum of 12 months. The three poor results all traced to inadequate DRUJ treatment — two missed DRUJ dislocations and one radial malunion — and the ulnar styloid base fracture was identified as a marker of persistent DRUJ instability.
Galeazzi fracture-dislocation: a new treatment-oriented classification
A classification by the distance of the radial fracture from the midcarpal joint. Type I (less than 7.5 cm) has a high rate of DRUJ disruption and all required ORIF; Type II (greater than 7.5 cm) has a lower rate. The distance reliably predicts DRUJ disruption. doi: 10.1053/jhsu.2001.21523.
The interosseous membrane of the forearm: structure and its role in Galeazzi fractures
Anatomic and biomechanical study showing the central band of the interosseous membrane is the primary stabiliser against radial shortening; disruption is proportional to injury energy and more proximal fractures. Restoring radial length tensions the IOM, which is the mechanism by which radius fixation stabilises the DRUJ.