It is known that the delayed diagnosis of Essex-Lopresti injury can lead to devastating results concerning the function of the upper extremity. The aim of our study is to suggest methods of early diagnosis and treatment based on our experience on ten patients who were treated for this rare injury.

We studied 10 patients (9 male and 1 female), average 36,5 years old (25–53) who sustained comminuted fracture of the radial head, isolated (3 patients) or with concomitant injury of the ipsilateral (3 patients) or the contralateral upper extremity (4 patients). Initially, 8 patients were treated with excision and 2 with internal fixation of the radial head and radioulnar transfixing pin. Gradually, they all developed subluxation of the DRUJ and they were treated for established Essex-Lopresti injury, 1–7 months after initial injury. Six patients were treated with reduction of radioulnar length (ulnar shortening osteotomy, with or without distraction with an external fixator) and TFC suturing. In 4 patients the radial head was replaced with a metallic implant, joint levelling and TFC suturing.

The results were estimated after an average follow-up of 67 months (1–10 years) based on radiological (radioulnar equivalence) and clinical criteria (wrist and elbow range of motion, forearm rotation and grip strength). Excellent results were achieved in 4 patients who underwent metallic radial head replacement. Conversely, in the rest patients the radioulnar discrepancy relapsed in various degrees but the radiological result does not correlate with the clinical picture.

We concluded that early diagnosis is necessary but not the only prerequisite for a good long-term result. Replacement of the radial head with titanium implant, offers good result at least in the short and mid-term period.

Aim : We investigated the combination of closed reduction, percutaneous osteosynthesis with screws and external fixation in the treatment of high-energy fractures of the tibial condyles with severe soft-tissue lesions.

Method : We studied 35 fractures (11 open) of the tibial condyles. Twenty-eight were Schatzker type VI, 5 type V and 2 type I. The fracture was reduced under fluoroscopic control and the articular surface was fixed with cannulated lag screws. In 23 patients (group A) a unilateral external fixation was applied with the proximal pins placed in the tibial condyles. In 12 patients (group B) an external fixation crossing the knee was used for 6 weeks followed by a knee brace. The follow-up period was 8–45 months

Results: All fractures united in a mean time of 15 weeks except for two in group A that needed conversion to internal fixation. Ten knees developed pintract infection. All knees had range of motion of at least 1000 except for one in group B that developed osteoarththritis. A collapse of the articular surface of more than 5mm and malalignment of more than 60 were observed in 7 and 5 patients in group A and B respectively.

Conclusions: Limited internal and external fixation are a satisfactory technique for selected fractures of the tibial plateau, particularly with poor soft-tissue envelope. Crossing the knee with the external fixator does not necessarily lead to significant stiffness.