Essex-Lopresti fracture

Background

• Triad of radial head fracture, disruption of interosseous membrane, and distal radioulnar joint disruption

Clinical Features

• Unstable and painful forearm
• Axial force from wrist to elbow after fall on outstretched hand
• Grip weakness and difficulty pronating wrist

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Biceps tendon rupture/dislocation
• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Pronator teres syndrome
• Septic bursitis

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Essex-Lopresti fracture with radial head fracture (left) and dorsal subluxation of the ulna (right).

Workup

• PA and lateral radiography of the elbow and forearm (may only show a radial head fracture)

Diagnosis

• The injury can be difficult to diagnose initially, as the attention is focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked.
• The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma.
• Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist
• Radial pull test: >3mm displacement dorsal/volar is consistent with Essex-Lopresti
• May require CT to evaluate subtle fractures

Management

• Orthopedic referral

Disposition

• Per ortho - usually outpatient operative management (radial head arthroplasty)

See Also

• Radial head fracture

References

• Williams D. Wrist and forearm. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2014.
• https://www.orthobullets.com/trauma/1019/radial-head-fractures