The treatment of longitudinal instability of the radius and ulna following trauma and radial head excision, the Essex-Lopresti injury has not met with a great deal of success. Isolated ulnar shortening osteotomy, TFCC repair, radial head prosthetic replacement, or reconstruction of the interosseous ligament have failed either experimental or clinical trials. Repair acutely, radial head allografts and bone-patella-bone reconstructions have met with some success. We present a new reconstruction for the Essex-Lopresti injury taking a more global approach to the problem. The interosseous membrane A-band is reconstructed using the pronator teres tendon as a graft by leaving it attached to its insertion on the radius, detaching it at its musculo-tendinous origin and reattaching it to the ulna distally. The TFCC is reattached to bone at the wrist. The ulna is shortened to level the distal radio-ulnar joint if necessary. The construct is supported with a titanium radial head prosthesis with the anticipation of the necessity for later removal. This procedure has been performed in 6 patients. The average age was 45.6 years. All were male with the dominant arm involved in 2 patients. All were workers compensation injuries. One patient was murdered and lost to follow-up 3 months post-op. This series reports the remaining 5 patients. Follow-up averaged 21 months with a range of 6 to 46 months.. The radial head prosthesis has been removed in 2 patients with follow-up of only 3 months. The range of motion averaged: Elbow: -18 to 130 degrees of flexion (-15-35 to124-140) Wrist: 54.8 degrees of dorsiflexion (50-70) 59 degrees of palmarflexion (30-65) 24 degrees of radial deviation (15-30) 29 degrees of ulnar deviation (28-35) 77.6 degrees of pronation (60-90) 68.4 degrees of supination (42-90) Grip: 64.4 lbs (38-84 lbs) 69.8% opposite (38-109%) Pinch: 19.8 lbs (16-29 lbs) 87.2% (64-96%) RTW: 4 pts The radial head prosthesis has been removed in two. Neither patient has had proximal migration of the radius and has not complained of wrist or elbow pain. This approach to the Essex-Lopresti injury has resulted in satisfactory results in this small group of patients. The follow-up for this problematic injury is short but has been encouraging.