Reading Forearm X-rays
Both-bone shafts, Galeazzi, and Monteggia on two views.
Aug 31, 2026 · 3 refs
At a glance
Forearm films are AP and lateral of the entire radius and ulna, including the elbow and wrist. A “both-bone” description that skips DRUJ and PRUJ is incomplete — Galeazzi and Monteggia live at the joints.
Technique pointers
Include the joints
- Whole shaft plus elbow and wrist on both views
- Radiocapitellar alignment (radius points at capitellum on every view)
- DRUJ / ulnar variance at the wrist; PRUJ at the elbow
Pattern
- Location (proximal / mid / distal third)
- Transverse vs oblique vs comminuted
- Rotation and shortening — the proximal fragment is the anatomic one
Decision-making
An isolated-looking radial shaft fracture is a Galeazzi until the DRUJ is cleared. An ulna shaft with a radio-capitellar miss is a Monteggia. If the joints are not on the film, you have not finished the study.
High-yield / exam
- Always include elbow and wrist
- Radiocapitellar line on every view
- Name Galeazzi / Monteggia when the joint is involved
- Do not accept a cropped midshaft cassette
Questions
Ortho Skills (Real Life) and Boards items for this topic are coming.
Your pearl
One line you’d tell a junior at 2am.
References
- 01
Diaphyseal forearm fractures — evaluation and management themes
2014 · Journal of the American Academy of Orthopaedic Surgeons · review
Joint-to-joint films catch Galeazzi and Monteggia equivalents.
- 02
OTA teaching on radius-ulna shaft radiographic evaluation
2019 · Orthopaedic Trauma Association · guideline
Both-bone injury is a forearm and a joint problem.
- 03
AO Principles — forearm shaft imaging and joint inclusion
2017 · Orthopaedic Trauma Association · guideline
Orthogonal views of the entire forearm are the baseline series.
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