The main injury we see involving the DRUJ is the Galeazzi fracture which is a fracture of the distal one-third of the radius with disruption of the distal radioulnar joint. Variants of this condition can be quite difficult to recognize.

Image 2 shows a distal third radius fracture with obvious disruption of the distal radioulnar joint. These injuries require operative care. Campbell described this injury as a "fracture of necessity" after a review of the poor results obtained after treating this injury with casting alone. With disruption of the joint the radius shortens and there are poor results featuring wrist pain and the lack of forearm rotation. Hughston found 35/38 patients treated with a cast for this fracture had poor results. A number of papers in the literature suggest that rigid anatomic fixation provides a much higher success rate.

I generally use the volar approach to the radius to fix these injuries. The posterior approach used to be more popular. The main advantages of the volar approach are that there is a flat surface upon which to place the plate - especially distally. There is less tendon irritation as the plate tends to be quite buried in the volar and more muscular aspect of the forearm. The posterior interosseous nerve is out of harm's way - especially with more proximal platings where there is a higher incidence of posterior interosseous nerve injury with the dorsal approach. A compression plate with a minimum of 6 holes is used to fix the radius.