Figure 1185902

Figure Legend: Combined fractures include three special combinations of injury: the Essex-Lopresti lesion (1),  Monteggia fracture-dislocation (2), and Galeazzi fracture-dislocation (left and 3). Galeazzi fracture-dislocation refers to a fracture of the shaft of the radius associated with dislocation of the distal radioulnar joint. Monteggia fracture-dislocation refers to fracture of the ulna with dislocation of the radial head. Each of these fracture-dislocation patterns is best treated with open fracture reduction and closed treatment of the dislocation. Essex-Lopresti lesion refers to longitudinal disruption of the radioulnar interosseous membrane and proximal migration of the radius associated with fractures involving the proximal radioulnar joint, the distal radioulnar joint, or both sites. The most common presentation of Essex-Lopresti is associated with radial head excision for fracture, resulting in ulnocarpal impingement syndrome. Treatment is controversial. When diagnosed acutely in the context of an unreconstructable radial head fracture, Essex-Lopresti justifies use of a temporary radial head implant. Late surgical options include ulnar shortening osteotomy or the developing technique of ligament reconstruction with a tendon graft.
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