When a fall on an outstretched hand leads to a comminuted radial head fracture, longitudinal radioulnar dissociation (LRUD) may result if the forearm interosseous ligament (IOL) tears as well. This is often referred to as the Essex-Lopresti lesion, and treatment has been very unsatisfactory, historically. While I worked at the University of Pittsburgh, earlier in my career, I was priviledged to work with talented engineers/scientists who helped me learn more about the biomechanics at work. This has allowed us to learn more about why past treatments have failed.
Our research/publications have led to a change in treatment, which includes radial head replacement at the elbow, and TFCC repair at the wrist. In order to restore load transfer to normal--at the elbow--IOL reconstruction is now feasible. This intervention is still somewhat experimental, but our knowledge of the biomechanics suggests that long-term success of radial head replacement will require that the IOL be reconstructed.
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