Management of the Essex-Lopresti Injury

Abstract

Essex-Lopresti injuries (ELIs) are characterized by fracture of the radial head, disruption of the forearm interosseous membrane, and dislocation of the distal radioulnar joint. This injury pattern results in axial and longitudinal instability of the forearm. Initial radiographs may fail to reveal the full extent of the injury, and therefore diagnosis in the acute setting requires a high index of suspicion. Early recognition and treatment are preferred as failure to fully treat the problem may result in chronic wrist pain from ulnar abutment or chronic elbow pain from radiocapitellar arthrosis. In this article the presentation, relevant anatomy, and management options for ELIs are overviewed, and a summary of outcomes reported in the literature is provided. Additionally, the preferred surgical technique of the senior author is presented, which involves reconstruction of the interosseous membrane with a local pronator rerouting autograft.

Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

“…Dislocation in dorsal direction is the result of axial loading of the wrist in extension and hyperpronation of the forearm, whereas the injury mechanism for dislocation in volar direction is axial loading of the wrist which is locked in supination combined with hypersupination of the forearm [29,30]. In contrast, the injury mechanism of Essex-Lopresti injury is axial compression loading of the forearm on the extended elbow [31]. It is important to know that both primarily isolated DRUJ dislocation and fracture-associated DRUJ dislocation (i.e.…”

“…Likewise, open reduction and internal fixation (ORIF) of the radial head in case of an Essex-Lopresti injury is the essential prerequisite to obtain the length of radius and to avoid subsequent longitudinal instability of the DRUJ (i.e. UPV) [31][32][33][34][35][36][37]55]. In every instance as well when evident DRUJ instability after closed or open reduction of traumatic DRUJ luxation in case of a Galeazzi injury ( Figures 8A-F), greater arc injury, acute isolated DRUJ dislocation injury, or Essex-Lopresti injury persists, radioulnar transfixation using Kirschner-wires is absolutely required to provide DRUJ stability as well as to give the IOM the chance for spontaneous healing [21,27,[31][32][33][34][35][36][37]55].…”

“…It is important to know that both primarily isolated DRUJ dislocation and fracture-associated DRUJ dislocation (i.e. Galeazzi) can be initially misdiagnosed radiographically up to 1 month ( Figures 7A-F), and additionally, only 20% of the Essex-Lopresti injury are fully recognized at time of initial presentation, and initial radiographs are often unremarkable that often results in undertreatment in the acute stage [27,[31][32][33][34][35]. It has also been reported that in case of a radial head fracture associated with an initially misdiagnosed Essex-Lopresti injury, primarily treated by ORIF and followed secondarily (6 months later) by radial head resection due to painful degeneration of the radial head, the proximal radial migration as result of the primarily misdiagnosed Essex-Lopresti injury could only been assessed 1 month after the radial head resection [36].…”

The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

“…1 There is a general consensus that acute surgery is preferred, but not always feasible. [1][2][3][4][5][6][7][8][9][10][11] Because diagnosis is not always immediately clear and this injury involves multiple structures, multiple surgeries are common. 4,[11][12][13][14] Surgical treatment of the proximal forearm ranges from radial head fixation to replacement, and treatment of the distal forearm ranges from simple immobilization to distal Long-Term Outcome after Essex-Lopresti Injury Verhiel et al…”

“…Late reconstruction may involve IOL reconstruction, or may involve late salvage such as Sauvé-Kapandji or creation of a single bone forearm. 3,[6][7][8][9][10][11] We sought to describe patient, injury, and treatment characteristics and to report long-term outcomes after treatment of patients presenting with ELI at a metropolitan health system encompassing two tertiary level academic medical centers.…”