Journal of Musculoskeletal Trauma

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]

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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Original Article

Hook plate versus periarticular-type volar locking plate for distal radius fractures involving the volar lunate facet in Korea: a retrospective cohort study: Hyun-Jae Park, Joo-Hak Kim; J Musculoskelet Trauma 2025;38(4):221-228. Published online October 24, 2025; DOI: https://doi.org/10.12671/jmt.2025.00241

Abstract PDF

Background
This study investigated the clinical and radiographic outcomes of hook plate (HP) fixation for volar lunate facet fractures, comparing them with periarticular-type volar locking plates (PVLPs).
Methods
A retrospective review was conducted on 24 patients with distal radius fractures involving volar lunate facet fragments who underwent surgery between January 2016 and April 2021. Patients were divided into two groups: HP (n=12) and PVLP (n=12). Radiographic union, wrist range of motion, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and implant-related complications were compared. Statistical analyses included the Mann-Whitney U test and Fisher exact test.
Results
Radiographic union was achieved in all patients (100%), without secondary displacement or hardware failure. No significant differences were observed between the two groups in wrist flexion (P=0.152), extension (P=0.832), pronation (P=0.792), or supination (P=0.328). The mean DASH scores were 12.8±5.5 in the HP group and 14.6±6.0 in the volar plate group (P=0.449). One patient in the HP group experienced mild flexor tendinopathy that resolved with conservative management. No cases of tendon rupture or early reoperation were reported.
Conclusions
Fixation of volar lunate facet fractures using a HP yielded clinical and radiographic outcomes comparable to those of PVLPs, with a low rate of complications and reliable bony union. Due to its mechanical stability, compatibility with standard surgical approaches, and low risk of flexor tendon irritation, the HP may serve as a valuable alternative for managing volar lunate facet fractures. Level of evidence: IV.

Citations

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Open distal radius fracture with ulnar neurovascular injury treated with dorsal spanning plate fixation and vein interposition grafting: a case report
Kyeong-Eon Kim, Ho-Yong Lee, Shin-Woo Lee, Ji-Sup Kim
Journal of Musculoskeletal Trauma.2026; 39(3): 262. CrossRef

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