![]() Often in Essex-Lopresti type injuries, attention is focused on the more obvious injury at the head of the radius and as a consequence the distal radioulnar displacement is overlooked at initial examination. ![]() The points of interest in this case are the unique mechanism of injury with the relation of the radius and the ulna distraction and the challenge of appropriate diagnosis and treatment. Impact of the radial head with the capitellum humeri as in the usual Essex-Lopresti fracture dislocation is unlikely. The avulsion fractures of the radial head are most likely to have occurred during medial and distal shear forces. This is best appreciated on CT ( figure 3). The radial head was ‘oversupinated’ with medial and distal displacement out of the ulnar notch. 6 The mechanism of injury in our case appears to have been different to those described above and is likely due to an impact onto a supinated forearm with simultaneous posterior to anterior impact on the radial head, subsequently resulting in radial head dislocation, rupture of the interosseous membrane and DRUJ distraction. 2 During an axial load the rotational position of the forearm appears to influence the type of injury, with pronation a common cause. 5 The fractured radial head dislocates, after which the interosseous membrane ruptures, the DRUJ dislocates and the radius migrates proximally. ![]() 1 3 4 An Essex-Lopresti fracture is a complex injury in which a longitudinal force is transmitted via the wrist to the radial head and if there is sufficient force, a continuum of injuries occurs. A Galeazzi injury is typically a result of a fall on an outstretched hand with extreme forearm pronation and a Monteggia fracture is also thought to be due to excessive forced pronation. Forearm injuries are commonly the result of a fall on an outstretched hand with a longitudinal force transmitted through the wrist in combination with a rotational force. ![]()
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