Progress in diagnosis and treatment of Essex-Lopresti injury in children.

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.