The Essex-Lopresti Injury: More Than Just a Pain in the Wrist

Abstract

As the scope of plastic surgical practice expands to include disorders of the carpus and wrist, it has become increasingly important for plastic surgeons to understand pathoanatomy that has not traditionally been considered an integral component of training. The Essex-Lopresti injury consists of a radial head fracture with associated injury to the forearm interosseus membrane and longitudinal instability of the distal radioulnar joint. Early recognition of this disorder usually results in a predictable and satisfactory outcome. However, when this disorder is unrecognized, late reconstruction is challenging and unpredictable, and treatment may be misdirected to the wrist alone if the forearm and elbow are not considered as a component of this injury. The present report describes the importance of examining the elbow in all cases of wrist pain. As well, the literature is reviewed regarding the differences in treatment of acute and chronic Essex-Lopresti injuries. As plastic surgeons become more involved in the treatment of wrist injuries, the conscientious practitioner should be aware of more complicated pathology that may present as a seemingly straightforward wrist problem.

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

“…Longitudinal forearm instability arises because of structural incompetence of the radial head, IOL, and DRUJ. 1,3,4,[18][19][20] Treatment approaches vary widely. We aimed to describe a cohort of patients including the treatment course and long-term patient-reported outcomes for this difficult injury pattern.…”

“…In our cohort, there were no attempts to directly address IOM injury surgically. 2,18,[22][23][24] In elbow fracture dislocations, radial head fractures with three or fewer articular fragments may be amenable to ORIF, but with multiple fragments in the unstable elbow, arthroplasty is recommended. 1,12,[25][26][27] Edwards and Jupiter found that radial excision alone led to poor results, and recommended an ulna shortening procedure with radial head arthroplasty when not immediately recognized as an ELI.…”

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

“…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].…”

“…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]. In contrast to the acute traumatic DRUJ dislocation injury, the EssexLopresti injury is primarily associated with a longitudinal radioulnar instability only whereas (sub)luxation in the lateral plane mostly occurs secondarily [24,[34][35][36][37]. However, in every instance in which an EssexLopresti is suggested, based on radiographic signs of a longitudinal instability in DRUJ, preexisting posttraumatic or degenerative changes which can be responsible for DRUJ instability must be clearly assessed to avoid an overtreatment ( Figures 8A-B).…”

“…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]. If a closed DRUJ reduction is unsuccessful due to soft tissue interposition such as the extensor digiti minimi tendon or the traumatically detached TFCC, the open reduction becomes necessary ( Figures 8A-F) [27].…”