A 30-year-old falls from a height. X-ray shows a comminuted fracture of the radial head with widening of the distal radioulnar joint on the opposite end of the forearm. MRI confirms extensive tearing of the interosseous membrane. The key principle guiding definitive management of this injury is:
- A Excision of the radial head fragments alone gives excellent results
- B Immediate below-elbow cast immobilisation for 6 weeks is sufficient
- C The radial head must be preserved or reconstructed because it acts as the main restraint to proximal migration of the radius ✓
- D Only the distal radioulnar joint requires stabilisation; the radial head can be ignored
Correct answer: C. The radial head must be preserved or reconstructed because it acts as the main restraint to proximal migration of the radius
Explanation
An Essex-Lopresti lesion combines a comminuted radial head fracture, disruption of the interosseous membrane and distal radioulnar joint disruption, creating longitudinal instability of the forearm. Once the radial head is lost, the interosseous membrane cannot prevent proximal migration of the radius. Therefore the radial head must be fixed or replaced with a prosthesis rather than simply excised. Excision alone converts the injury into chronic proximal migration with wrist pain.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.