Essex-Lopresti, J Bone Joint Surg Br 1951 - Fractures of the Radial Head with Distal Radio-Ulnar Dislocation; Report of Two Cases

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Fractures of the Radial Head with Distal Radio-Ulnar Dislocation; Report of Two Cases

Essex-Lopresti·J Bone Joint Surg Br·1951·325 citations·Case series

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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.

Key Findings

After radial head excision in Case 1, the radial shaft migrated proximally until it contacted the capitulum. Only then was the DRUJ dislocation recognized. This is the paper's defining catastrophe and the reason radial head excision alone is now contraindicated in this setting.
Relative radial shortening compared to the ulna was visible on the initial elbow radiograph and was the missed sign of longitudinal forearm disruption. The diagnosis was available from the first film — it was simply not recognized.
Once the radial head was removed, the radius could be manually reduced but could not be held despite traction. This proves the radial head is the last remaining longitudinal stabilizer when the interosseous membrane is torn.
A depressed radial styloid fracture at the wrist confirmed the axial compression mechanism and longitudinal force transmission along the full forearm. Wrist films are mandatory in every comminuted radial head fracture.
The injury mechanism requires arms nearly extended under axial load:
- Sudden arrest drives the radial shaft proximally into the head
- Interosseous membrane disrupts along the full forearm length
- DRUJ dislocates as the distal radius loses its longitudinal restraint

Board PearlRadial head excision with unrecognized interosseous membrane disruption causes unstoppable proximal radial migration — preserve or replace the radial head.

Fractures of the Radial Head with Distal Radio-Ulnar Dislocation; Report of Two Cases.

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|

Fractures of the Radial Head with Distal Radio-Ulnar Dislocation; Report of Two Cases

Essex-Lopresti·J Bone Joint Surg Br·1951·325 citations·Case series

|

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.

Key Findings

After radial head excision in Case 1, the radial shaft migrated proximally until it contacted the capitulum. Only then was the DRUJ dislocation recognized. This is the paper's defining catastrophe and the reason radial head excision alone is now contraindicated in this setting.
Relative radial shortening compared to the ulna was visible on the initial elbow radiograph and was the missed sign of longitudinal forearm disruption. The diagnosis was available from the first film — it was simply not recognized.
Once the radial head was removed, the radius could be manually reduced but could not be held despite traction. This proves the radial head is the last remaining longitudinal stabilizer when the interosseous membrane is torn.
A depressed radial styloid fracture at the wrist confirmed the axial compression mechanism and longitudinal force transmission along the full forearm. Wrist films are mandatory in every comminuted radial head fracture.
The injury mechanism requires arms nearly extended under axial load:
- Sudden arrest drives the radial shaft proximally into the head
- Interosseous membrane disrupts along the full forearm length
- DRUJ dislocates as the distal radius loses its longitudinal restraint

Board PearlRadial head excision with unrecognized interosseous membrane disruption causes unstoppable proximal radial migration — preserve or replace the radial head.

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