The Essex-Lopresti injury results from a high energy trauma to the upper extremity causing significant instability to the forearm joint. The radial head is fractured, the interosseous membrane is torn, and the distal radioulnar joint is disrupted. Frequently, the greatest challenge with this specific injury pattern is the diagnosis, because it is often missed in the emergency room. Once the diagnosis has been established, surgical treatment focuses on the elbow (radial head fracture) and the wrist (distal radioulnar joint disruption) to restore forearm length and stability. Chronic or untreated Essex-Lopresti lesions continue to challenge treating physicians and often require salvage or reconstructive procedures to minimize pain and return function.