Essex-Lopresti Lesions and Longitudinal Radioulnar Instability

Abstract

An Essex-Lopresti injury (ELI) is classically described as a radial head fracture with a concomitant interosseous ligament complex (IOC) injury. However, multiple injury patterns may be present, and an interosseous membrane (IOM) injury should be evaluated for in any axial load injury through the forearm. ELI may result in longitudinal radioulnar instability (LRUI).» Diagnosis of an IOC injury can be difficult. Evaluation begins with standard wrist and elbow radiographs and is supplemented with radiographs and intraoperative maneuvers to assess for proximal radial migration. Magnetic resonance imaging and ultrasonography may be useful in the acute setting, although indications and the clinical importance of the findings remain unclear.» Surgical management of an acute ELI is focused on restoration of radial length and temporary distal radioulnar joint (DRUJ) stabilization. Radial head excision in the acute setting should be approached with caution because proximal migration may not be present acutely but may develop over time. The indication for acute IOM repair and reconstruction remains unclear.» Surgical management of a chronic ELI is focused on restoration of radial length, wrist leveling, and treatment of degenerative changes (either at the radiocapitellar joint or the DRUJ). Reconstruction of the central band can restore forearm load transfer and produce favorable functional outcomes, but its indications continue to be debated.

Defining acute Essex-Lopresti injuries is problematic and variable: a systematic review

“…Treatment of acute cases typically involves stabilization of the proximal radius (osteosynthesis or arthroplasty) and of the DRUJ. There is currently insufficient evidence regarding an additive effect of IOM repair/reconstruction in these cases ( 9 ).…”

“…Therefore, exactly defining Essex-Lopresti (EL) injury is very important, especially in the acute setting. However, while EL injury has been given considerable attention in the recent orthopedic literature ( 9 ), diagnostic criteria do not seem to be used uniformly throughout the literature, probably due to its rarity in clinical practice.…”