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Background
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
Radiograph-Positive
Radiograph-Negative
Pediatric
Evaluation
Essex-Lopresti fracture with radial head fracture (left) and dorsal subluxation of the ulna (right).
Workup
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
Disposition
- Per ortho - usually outpatient operative management (radial head arthroplasty)
See Also
External Links
References