A 45-year-old man with a radial head fracture develops wrist and elbow pain one year later. X-ray shows a 'carpal supination' deformity with ulnar head prominence at the wrist. The injury most likely also disrupted:

• A The medial (ulnar) collateral ligament of the elbow
• B The anterior interosseous nerve
• C The interosseous membrane of the forearm and distal radioulnar joint (Essex-Lopresti injury) ✓
• D The biceps tendon insertion at the radial tuberosity

Explanation

Essex-Lopresti injury is a radial head fracture combined with disruption of the central band of the interosseous membrane and the triangular fibrocartilage complex (TFCC) at the distal radioulnar joint. The radius migrates proximally (radial shortening), the ulnar head becomes prominent (positive ulnar variance), and forearm rotation is impaired. This injury is frequently missed acutely; radial head replacement (not excision alone) is critical to maintain the radial length and stabilise the forearm.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.