When a fall on an outstretched hand leads to a comminuted radial head fracture, longitudinal radioulnar dissociation (LRUD) may result if the forearm interosseous ligament (IOL) tears as well. This is often referred to as the Essex-Lopresti lesion, and treatment has been very unsatisfactory, historically.
While I worked at the University of Pittsburgh, earlier in my career, I was priviledged to work with talented engineers/scientists who helped me learn more about the biomechanics at work. This has allowed us to learn more about why past treatments have failed.
Our research/publications has underscored that treatment must include either radial head repair or radial head replacement at the elbow---never excision, and TFCC repair at the wrist with temporary DRUJ pinning.
Because the IOL results in normal load transfer from radius to ulna, restoration of normal load transfer at the elbow requires IOL reconstruction; however, this is still not commonly performed and is still somewhat experimental. Our knowledge of the biomechanics suggests that long-term outcomes of radial head replacement for LRUD will be compromised by capitellar arthritis and ulnar impaction at the wrist. Salvage procedures for these types of problems may include ulnar shortening osteotomy distally at the wrist and uni-arthroplasty (capitellar resurfacing) at the elbow.
