Ballistic Galeazzi Fractures: A Case Series

Galeazzi fractures, defined as fractures of the radial shaft with associated dislocation of the distal radioulnar joint (DRUJ), are uncommon injuries typically caused by high-energy blunt trauma or falls onto an outstretched hand. Ballistic mechanisms rarely produce this fracture pattern because they lack the torsional forces usually required to disrupt the DRUJ. Only isolated case reports of such injuries exist in the literature. This report presents the largest known case series of Galeazzi fractures resulting from gunshot wounds, providing new insight into their mechanism, management, and outcomes.

Six patients, four males and two females, between 25 and 52 years of age, sustained Galeazzi fractures following low-velocity gunshot wounds. Several were polytraumatized with concomitant injuries to other extremities or the abdomen. All patients underwent operative fixation of the radial shaft using rigid internal fixation constructs. In each case, the DRUJ was evaluated intraoperatively after fixation and was found to be stable without the need for additional surgical stabilization. Post-operative immobilization consisted of short-term splinting followed by early mobilization. At follow-up, all patients demonstrated fracture healing and functional forearm rotation without pain or DRUJ instability. Despite an average of 10.9 mm of initial radial shortening relative to the ulna, no patient developed instability requiring further surgical intervention.

This case series expands current understanding of Galeazzi fracture patterns by demonstrating that ballistic mechanisms, though uncommon, can produce this distinctive injury without the classic torsional loading. These findings suggest that stable DRUJ alignment can often be achieved through rigid fixation of the radial shaft alone, even in the setting of significant shortening from ballistic trauma. This report adds novel evidence to the orthopedic literature by highlighting a previously underrecognized mechanism of Galeazzi injury. It supports the importance of thorough intraoperative assessment of DRUJ stability following fixation. The clinical impact extends beyond trauma surgery by reinforcing that fracture pattern, rather than mechanism alone, should guide management decisions.