Acta Orthopaedica 2011; 82 (3): 356–359 height (Dodds et al. 2008, Green and Zelouf 2009). However, in the literature, a varying degree of force has been said to be required to disrupt the triangular fibrocartilage complex, the interosseous ligament, and to fracture the radial head (Hotch- kiss et al. 1989, Wallace et al. 1997). It has been suggested that the wide range of forces quoted may be related to the position of the forearm at the time of injury (Manson et al. 2000, Markolf et al. 2000, Shepard et al. 2001). We feel that, irrespective of the mechanism of injury, it is essential to per- form a full assessment of the forearm to exclude the presence of an Essex-Lopresti lesion. We routinely use radiographs as our initial line of investiga- tion (Edwards and Jupiter 1988, Jungbluth et al. 2006, Yeh et al. 2001). Radiographs of the wrist should include a “true lat- eral” radiograph, as well as satisfactory true posterior-anterior views in neutral rotation, to ascertain whether there is sublux- ation or dislocation of the distal radioulnar joint (Edwards and Jupiter 1988, Yeh et al. 2001). Bilateral comparison enables assessment of the individual’s normal ulnar variance on the uninjured side. Ultrasound, CT, and MRI have been shown to provide accurate information regarding the integrity of the interosseous membrane and confirmation of congruency of the distal radioulnar joint (Mino et al. 1983, Starch and Dabezies 2001, Wallace 2002). The main strength of our study is that it represents a large, unselected series of patients with a proximal radial fracture, with prospective data collection. Our short-term follow-up, with some patients not completing a full year follow-up, along with the small numbers, is a drawback. However, as we are the only primary acute musculoskeletal trauma service for the local adult population, it can be argued that most of these patients did not re-attend as they were asymptomatic. We do not routinely perform an MRI unless instability is suspected. The lack of MRI to confirm the diagnosis might be criticized, however. In some institutions, the availability of such imaging facilities may be limited and might cause delay in the diagno- sis and treatment of the patient. Further work in this area using MRI would be beneficial. All the authors contributed to data collection, literature analysis, and manu- script preparation. We thank the Scottish Orthopaedic Research Trust into Trauma (SORT-IT) for their assistance in performing this study. We also thank Dr R Elton for his help with the statistical analysis. No competing interests declared. Bruckner J D, Alexander A H, Lichtman D M. Acute dislocations of the distal radioulnar joint. Instr Course Lect 1996; 45: 27-36. 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