Acute Capitellum Fracture with Distal Radio-ulnar Joint Disruption: An Atypical Variant of an Essex Lopresti Injury -...

The Essex-Lopresti injury, as defined in the literature, is characterized by a distinct triad: Radial head (RH) fracture, tearing of the interosseous membrane and disruption of the distal radioulnar joint (DRUJ). We present an atypical case of DRUJ disruption resulting from a displaced capitellum fracture rather than an RH fracture.

A 35-year-old female sustained a distal humerus capitellum fracture with associated DRUJ instability following a high-energy mechanical fall. Surgical management involved open reduction and internal fixation (ORIF) of the capitellum fracture using headless compression screws, along with closed reduction and plaster cast immobilization of the DRUJ.Post-operative radiographs confirmed satisfactory position and healing of the capitellum fracture and restoration of DRUJ stability. Clinically, the patient demonstrated a stable full range of motion at both the wrist and elbow with good function.

Due to the potential dysfunction of these complex injury patterns, we feel displaced capitellum fractures should prompt a higher index of suspicion for associated DRUJ injury, warranting thorough examination and appropriate imaging of the forearm and wrist also. Capitellum ORIF, along with reduction and plaster cast stabilisation of the DRUJ, followed by appropriate rehabilitation, can lead to successful outcomes in such cases.