356 Acta Orthopaedica 2011; 82 (3): 356–359 Radial shortening following a fracture of the proximal radius Degree of shortening and short-term outcome in 22 proximal radial fractures Andrew D Duckworth1, Bruce S Watson1, Elizabeth M Will2, Brad A Petrisor3, Phillip J Walmsley, Charles M Court-Brown1, and Margaret M McQueen1 1Edinburgh Orthopaedic Trauma Unit and 2SORT-IT, Edinburgh Royal Infirmary, Edinburgh, UK; 3Orthopaedic Trauma Service, Hamilton General Hospital, Hamilton, ON, Canada; 4Department of Trauma and Orthopaedic Surgery, Queen Margaret Hospital, Dunfermline, UK Correspondence: andrew.duckworth@yahoo.co.uk Submitted 10-10-07. Accepted 11-01-10 Background and purpose The Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short- term outcome in these patients. Patients and methods Over an 18-month period, we prospec- tively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5–12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation. Results 60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2–4mm) was seen in 22 patients (mean age 48 (19–79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were man- aged nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury. Interpretation The incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases. Open Access - This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited. DOI 10.3109/17453674.2011.574563 The Essex-Lopresti lesion is the eponym given to radio-ulnar instability caused by sequential injury to the distal radio-ulnar joint, the interosseous membrane, and fracture of the proximal radius (Essex-Lopresti 1951). The original paper by Essex- Lopresti suggested that this is a rare injury, with subsequent literature indicating that the lesion is present in approximately 1% of all radial head fractures (Essex-Lopresti 1951, Trous- dale et al. 1992). A varying degree of force, in order to sustain such an injury, has been reported (Hotchkiss et al. 1989, Wal- lace et al. 1997). The diagnosis and treatment are challenging, with further imaging used when an unstable lesion is suspected (Starch and Dabezies 2001, Wallace 2002). When there is instability, open reduction and internal fixation or radial head replacement with added longitudinal stabilization of the forearm bones is rec- ommended (Lewin 1973, Edwards and Jupiter 1988, Bruckner et al. 1996). A recent study has shown that the incidence of associ- ated injuries following radial head fractures is high on MRI (Kaas et al. 2010). The purpose of our study was to describe the spectrum of radial shortening suggestive of an Essex- Lopresti lesion that occurs following a radial head or neck fracture, along with determining the short-term outcome in these patients.  Patients and methods Our trauma unit treats a defined population of over 500,000, and is the primary acute musculoskeletal trauma service for the local adult population (≥ 13 years of age). Over an 18-month period, we performed a prospective analysis of all patients who presented to our unit with a closed proximal radial fracture (Duckworth et al. 2011). This study focused