A 1951 two-case report from Birmingham describing comminuted radial head fractures combined with distal radio-ulnar joint dislocation after violent axial forearm compression. The paper asks what happens when this combined injury goes unrecognized and the radial head is excised. Case 1 provided the catastrophic answer and named a lesion every orthopedic trainee must know.
Every comminuted radial head fracture hides a possible Essex-Lopresti lesion until proven otherwise. Before you touch the radial head, check the elbow film for relative radial shortening, then image the wrist for DRUJ dislocation and radial styloid fracture. If longitudinal instability is suspected, radial head excision alone is absolutely contraindicated.
The radial head is the only remaining longitudinal stabilizer once the interosseous membrane is torn. Removing it produces proximal radial migration that cannot be controlled with traction or splinting.
This single case report, published in 1951, is why radial head preservation or prosthetic replacement is now standard when Essex-Lopresti injury cannot be excluded. Residents still miss the initial radiographic clue — relative radial shortening on the elbow film. Exactly as it was missed in Case 1.
A 1951 two-case report from Birmingham describing comminuted radial head fractures combined with distal radio-ulnar joint dislocation after violent axial forearm compression. The paper asks what happens when this combined injury goes unrecognized and the radial head is excised. Case 1 provided the catastrophic answer and named a lesion every orthopedic trainee must know.
Every comminuted radial head fracture hides a possible Essex-Lopresti lesion until proven otherwise. Before you touch the radial head, check the elbow film for relative radial shortening, then image the wrist for DRUJ dislocation and radial styloid fracture. If longitudinal instability is suspected, radial head excision alone is absolutely contraindicated.
The radial head is the only remaining longitudinal stabilizer once the interosseous membrane is torn. Removing it produces proximal radial migration that cannot be controlled with traction or splinting.
This single case report, published in 1951, is why radial head preservation or prosthetic replacement is now standard when Essex-Lopresti injury cannot be excluded. Residents still miss the initial radiographic clue — relative radial shortening on the elbow film. Exactly as it was missed in Case 1.