A 14-year-old patient who fell on an outstretched hand has pain along the forearm with point tenderness proximal to the wrist and over the proximal ulna. An X-ray will most likely show which fracture?

• A. Monteggia's fracture/dislocation
• B. Galeazzi's fracture/dislocation
• C. Colles' fracture
• D. Smith's fracture

Answer: (B)

When a fall on an outstretched hand injures the forearm, consider injuries of the distal radius and the distal radioulnar joint (DRUJ). A Galeazzi fracture is defined by a fracture of the distal radius with dislocation or subluxation of the DRUJ. The radiographic hallmark is a distal radius fracture accompanied by instability or misalignment at the joint where the radius and ulna meet near the wrist. This pattern contrasts with other distal radius injuries: a Colles fracture is a distal radius fracture with dorsal angulation but an intact DRUJ; a Smith fracture is a distal radius fracture with volar displacement of the fragment; and a Monteggia fracture is a fracture of the proximal ulna with dislocation of the radial head at the elbow. The described mechanism and forearm tenderness point to a Galeazzi-type injury, where the key feature is the distal radius fracture with DRUJ disruption seen on X-ray.