Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion

Abstract

The Essex-Lopresti lesion is a challenging injury both for diagnosis and management. These often tend to be missed, resulting in incapacitating pain and joint stiffness despite treatment. In rare circumstances, they may occur in association with other injuries of the forearm or elbow. We describe an atypical Essex-Lopresti variant comprising a radial head and shaft fracture with an associated distal radioulnar joint dislocation in a 36-year-old man.T he classic Essex-Lopresti lesion, which comprises a fracture of the radial head, disruption of the interosseous membrane, and a dislocation of the distal radioulnar joint (DRUJ), was first introduced by Curr and Coe 1 in 1946 and later described and named after Peter Essex-Lopresti 2 in 1951. Another eponymous fracture, named after Italian surgeon, Riccardo Galeazzi, 3,4 comprises a fracture of the radial shaft along with disruption of the DRUJ. The mechanism of injury in both these injuries is similar, primarily, an axially directed force along the long axis of the forearm, which results in a traumatic dislocation of the DRUJ, disruption of the interosseous membrane, and with continued force, a compression type fracture or dislocation of the radial head. A few rare variants of the abovementioned patterns have been described in the literature, although the combination of a Galeazzi fracture and an Essex-Lopresti lesion has been reported only twice. We report a distinct and rare variant of the abovementioned combination which comprised a concomitant radial head and shaft fracture along with a DRUJ dislocation.