title: Radial shortening following a fracture of the proximal radius.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Over an 18-month period, we prospectively 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 managed 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Edinburgh Orthopaedic Trauma Unit, Edinburgh Royal Infirmary, Edinburgh, UK. andrew.duckworth@yahoo.co.uk
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Duckworth
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Watson
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Will
authors.forename: Brad A
authors.initials: BA
authors.lastname: Petrisor
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Walmsley
authors.forename: Charles M
authors.initials: CM
authors.lastname: Court-Brown
authors.forename: Margaret M
authors.initials: MM
authors.lastname: McQueen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D011884:Radius / Q000000981:diagnostic imaging / Q000601:surgery; D011885:Radius Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D011795:Surveys and Questionnaires; D014457:Ulna / Q000000981:diagnostic imaging / Q000601:surgery