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

Verhiel, Svenna H. W. L.; Özkan, Sezai; Langhammer, Christopher G.; Chen, Neal C.

doi:10.1055/s-0039-3401380

Cited by 7 publications

(4 citation statements)

References 31 publications

(62 reference statements)

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“…Our initial search revealed 47 eligible articles ( 6 , 7 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ) ( Fig. 1 ), of which 27 were case reports and 20 were case series.…”

Section: Resultsmentioning

confidence: 99%

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

Kooistra¹,

Bekerom

Priester-Vink

et al. 2022

EFORT Open Reviews

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Purpose The aim of this study was to systematically review clinical studies on the employed definitions of longitudinal forearm instabilities referred to as Essex-Lopresti (EL) injuries, interosseous membrane (IOM) injuries or longitudinal radioulnar dissociation. Methods A systematic literature search was performed in MEDLINE, Embase, CINAHL, Web of Science and Cochrane databases, adhering to PRISMA guidelines. All data on diagnosis and treatment were collected. Results In total, 47 clinical studies involving 266 patients were included. Thirty-nine of 47 studies did not mention an IOM lesion as part of the EL injury. The amount of preoperative positive ulnar variance varied from >1 to >12 mm. Nine studies used some form of dynamic pre-operative or intraoperative test of longitudinal radioulnar instability. Conclusions There is no accepted definition of EL injury in the literature. In order to prevent underdetection of acute EL injury, a radial head fracture in a patient with wrist and/or forearm pain should raise awareness of the possibility of an EL injury. In this case, comparative radiographic studies and some form of dynamic assessment of longitudinal radioulnar stability should be performed.

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Section: Resultsmentioning

confidence: 99%

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

Kooistra¹,

Bekerom

Priester-Vink

et al. 2022

EFORT Open Reviews

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“…While we believe a radial head, replacement adds to the stability of the forearm, in our case damage to the proximal radius after loosening of the primary RH arthroplasty precluded the reliable use of a revision arthroplasty. The limited available evidence suggests that satisfactory results can be achieved by IOM reconstruction without the use of a RH arthroplasty [2,19].…”

Section: Resultsmentioning

confidence: 99%

Long-term Outcome of Surgical Reconstruction of the Interosseous Membrane after Chronic Essex-Lopresti Injury

MJ¹,

SA²,

Barco³

2020

GSCR

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An Essex-Lopresti injury (ELI) is a rare lesion that describes an interosseous membrane (IOM) disruption associated with dislocation of the distal radio-ulnar joint (DRUJ) and radial head fracture. They are rare and have a tendency to be underdiagnosed in the ER, so it is not uncommon to see chronic cases. As part of the treatment options different IOM reconstructions have been proposed along with associated procedures to the radial head and DRUJ. One of the most effective treatment strategies has been the use of a bone-tendonbone (BTB) patellar graft for IOM reconstruction with promising outcomes. We present a case of 46-yearold man who suffered an Essex-Lopresti injury with a radial head fracture and associated posterolateral elbow instability that was managed initially non-operatively. After failure for continued pain and instability if the elbow and forearm, we treated the patient with a radial head arthroplasty, ligament reconstruction of the posterolateral complex, and DRUJ ligament reconstruction with extensor hallucis tendon without a formal IOM. This operation was successful initially, but continued forearm instability contributed to failure of the RHA and DRUJ reconstruction. A second operation was performed resecting the loosened radial head arthroplasty, performing an ulnar shortening osteotomy, and an IOM reconstruction with BTB allograft. After eight years of follow-up the patient is very satisfied with the procedure and rates his elbow as almost normal. ELI are rare and represent a severe injury of the forearm with axial and transverse instability, leading to severe symptoms and instability of the forearm. Initial diagnosis is challenging, and acute treatment yields better results than chronic cases. IOM reconstruction seems to be necessary in the setting of chronic reconstructions, along with other procedures to balance the forearm. We review different IOM grafting options and associated procedures for the treatment of these challenging injuries.

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“…20 Addressing the injury to the radial head alone by osteosynthesis or arthroplasty fails to restore forces across the forearm, which can lead to radiocapitellar degeneration, failure of osteosynthesis, or failure of radial head arthroplasty through loosening, dislocation, or capitellar erosion. 21,22 Verhiel et al 23 reported 32 revision procedures in 16 patients with longitudinal instability lesions treated with radial head arthroplasty over a ten-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

Gallego,

Rotman,

Watts

2024

Bone Joint J

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AimsAcute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm.MethodsAn independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months’ follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score.ResultsOf the 18 patients (nine male, nine female) who met the inclusion criteria, the median follow-up was 8.5 years (interquartile range (IQR) 5.6 to 10). Their mean age was 49 years (SD 11). The mean extension improved significantly from 38° (SD 15°) to 24° (SD 9°) (p = 0.027), with a mean flexion-extension arc change from 81° (SD 27°) to 93° (SD 30°) (p = 0.172) but with no forearm rotational improvement (p = 0.233) at latest follow-up. The QuickDASH functional score improved significantly from 80 (SD 14) to 52 (SD 26) following reconstruction (p = 0.031), but generally the level of disability remains high. Radiological assessment showed no progression of proximal migration of the radius, with a stable interbutton distance and ulnar variance from immediate postoperative radiograph to the latest follow-up.ConclusionCentral band interosseus membrane reconstruction using a synthetic braided cross-linked graft can improve patient-rated arm function and range of motion, but significant functional deficits remain in patients with chronic injuries.Cite this article: Bone Joint J 2024;106-B(2):182–188.

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

Cited by 7 publications

References 31 publications

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

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

Long-term Outcome of Surgical Reconstruction of the Interosseous Membrane after Chronic Essex-Lopresti Injury

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

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