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World J Orthop. Jun 18, 2025; 16(6): 106758
Published online Jun 18, 2025. doi: 10.5312/wjo.v16.i6.106758
Progress in diagnosis and treatment of Essex-Lopresti injury in children
Feng Xiang, Ding-Qi Zhang, Juan Guo, Xing Li, Xi-Ping Zhang, Yan-Jun Li, Jie Wen
Feng Xiang, Ding-Qi Zhang, Xi-Ping Zhang, Yan-Jun Li, Department of Traumatic Orthopedics, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
Juan Guo, Department of Humanities and Journalism, Xiamen University Tan Kah Kee College, Zhangzhou 363123, Fujian Province, China
Xing Li, Department of Integrated Chinese and Western Medicine, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College, Central South University, Zhuzhou 412007, Hunan Province, China
Jie Wen, Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha 410013, Hunan Province, China
Co-first authors: Feng Xiang and Ding-Qi Zhang.
Co-corresponding authors: Yan-Jun Li and Jie Wen.
Author contributions: Xiang F designed research; Zhang DQ performed research; Guo J contributed analytic tools; Li X analyzed data; Zhang XP did data curation; Li YJ revised the paper; Wen J supervised and revised the paper. Xiang F and Zhang DQ contributed equally to this work as co-first authors. Xiang F and Zhang DQ contribute equally to this study, they shared co-first author. Li YJ and Wen J contribute equally to this study, they revised the paper and shared co-corresponding author. This research was jointly completed by two institutions, Zhuzhou Central Hospital and Hunan Provincial People's Hospital. Among the corresponding authors, Professor Li YJ from Zhuzhou Central Hospital was responsible for the conception of the entire research and various resources to ensure the progress of the research, and played an irreplaceable role in the revision process of the article. Professor Wen J from Hunan Provincial People's Hospital was responsible for the control of the entire research period, as well as the overall control and supervision of the processes such as literature search, analysis, and graphing. He also played a significant role in the revision of the paper. The two corresponding authors have played significant and equal roles in the execution, progress, completion of this study and the writing of the paper. Therefore, these two professors are marked as co-corresponding authors in this paper.
Supported by Science Project of Hunan Provincial Healthy Commission, No. 20230844; and Science Project of Hunan Natural Science Foundation, No. 2025JJ81181.
Conflict-of-interest statement: The authors have no competing interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Wen, Associate Professor, Department of Pediatric Orthopedics, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, No. 61 West Jiefang Road, Changsha 410013, Hunan Province, China. cashwj@qq.com
Received: March 7, 2025
Revised: April 16, 2025
Accepted: May 21, 2025
Published online: June 18, 2025
Processing time: 104 Days and 4.8 Hours
Abstract

Essex-Lopresti injury is characterized by a radial head fracture accompanied by dislocation of the distal radioulnar joint and rupture of the interosseous membrane (IOM). This type of injury typically results from high-energy axial forces transmitted through the wrist to the elbow, leading to tears in the IOM, fractures of the radial head, injuries to the distal radioulnar joint, and disruption of the triangular fibrocartilage complex, ultimately causing axial instability of the radioulnar joint. Due to its complexity, this injury is often overlooked in clinical settings, with a reported misdiagnosis rate as high as 60%. In pediatric cases, the misdiagnosis rate is even higher due to children's limited ability to articulate symptoms, the presence of substantial cartilaginous structures that have not fully ossified, and less typical radiographic findings compared to adults. This review aims to provide a comprehensive overview of the injury mechanism, clinical presentation, diagnosis, and treatment of Essex-Lopresti injuries in children, emphasizing the importance for pediatric orthopedists to recognize and manage this condition accurately to prevent misdiagnosis and inappropriate treatment.

Keywords: Essex-Lopresti injuries; Fractures of the radial head; Tears in the interosseous membrane; Dislocation of the radioulnar joint

Core Tip: Essex-Lopresti injury is often overlooked in clinical settings, with a reported misdiagnosis rate as high as 60%. In pediatric cases, the misdiagnosis rate is even higher due to children's limited ability to articulate symptoms, the presence of substantial cartilaginous structures that have not fully ossified, and less typical radiographic findings compared to adults. This review aims to provide a comprehensive overview of the injury mechanism, clinical presentation, diagnosis, and treatment of Essex-Lopresti injuries in children, emphasizing the importance for pediatric orthopedists to recognize and manage this condition accurately to prevent misdiagnosis and inappropriate treatment.