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Case Report
- Progressive forearm instability after anatomical union of a radial head fracture: a case report of a challenging Essex-Lopresti injury
- SeongJu Choi
- Received April 6, 2026 Accepted May 26, 2026 Published online July 20, 2026
- DOI: https://doi.org/10.12671/jmt.2026.00157 [Epub ahead of print]
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Abstract
PDF - Essex-Lopresti injuries remain challenging because anatomical restoration of bony structures does not always re-establish functional forearm stability. We report the case of a 51-year-old male patient who sustained an elbow dislocation, comminuted radial head and neck fracture, and distal radioulnar joint (DRUJ) dissociation after falling from a bicycle. He underwent open reduction and internal fixation of the radial head, interosseous membrane augmentation using a suture-button construct, and temporary DRUJ pinning. Immediate postoperative radiographs showed apparent restoration of radial length, and radiographic union of the radial head was achieved. However, ulnar-sided wrist pain initially improved but progressively recurred by 6 months, with increasing ulnar-positive variance and DRUJ widening. Elbow motion was preserved, but forearm rotation was limited, and computed tomography demonstrated heterotopic ossification around the radial head. Ulnar shortening osteotomy and radial head arthrolysis were performed as a second procedure, after which mechanical instability developed, with irreducible anterior dislocation of the radial head. A third operation, consisting of annular ligament reconstruction using a palmaris longus autograft, restored proximal radioulnar joint stability, although substantial limitation of forearm rotation persisted. This case highlights that even radiographic union and multistructural initial management may fail to restore balanced forearm mechanics in Essex-Lopresti injury. Level of evidence: V.
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