The treatment of the acute Essex-Lopresti injury

Abstract

The Essex-Lopresti injury (ELI) of the forearm is a rare and serious condition which is often overlooked, leading to a poor outcome. The purpose of this retrospective case study was to establish whether early surgery can give good medium-term results. From a group of 295 patients with a fracture of the radial head, 12 patients were diagnosed with ELI on MRI which confirmed injury to the interosseous membrane (IOM) and ligament (IOL). They were treated by reduction and temporary Kirschner (K)-wire stabilisation of the distal radioulnar joint (DRUJ). In addition, eight patients had a radial head replacement, and two a radial head reconstruction. All patients were examined clinically and radiologically 59 months (25 to 90) after surgery when the mean Mayo Modified Wrist Score (MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores (MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome. In case of a high index of suspicion for ELI in patients with a radial head fracture, we recommend the following: confirmation of IOM and IOL injury with an early MRI scan; early surgery with reduction and temporary K-wire stabilisation of the DRUJ; preservation of the radial head if at all possible or replacement if not, and functional bracing in supination. This will increase the prospect of a good result, and avoid the complications of a missed diagnosis and the difficulties of late treatment.

Management of the Essex-Lopresti Injury

“…14,25 Several authors have described managing acute ELI injuries with radial head ORIF or replacement and stabilization of the DRUJ without reconstructing the IOM. 6,21,31,38 However, there is concern that the IOM may not heal properly even if approximated well, possibly due to interposition of muscle. 39 Furthermore, even if USO is performed for ensuing chronic ulnar abutment, the radius may continue to migrate proximally if the IOM is disrupted.…”

Evaluation of Overlooked Fractures - Dislocations and Trauma Series

“…Bu yaralanma sıklık-la atlanmaktadır. [9,10] Benzer şekilde Galeazzi kırığındaki distal radioulnar eklem (DRUE) lezyonu atlanabilir.…”

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm

“…The IOM plays an important role in this synergy. The role of proprioception in dynamic neuromuscular control of the forearm stability is important, therefore, for the treatment of forearm injuries involving bone, ligaments and joint capsules (Essex-Lopresti, 1951;Sabo & Watts, 2012;Grassmann et al 2014;Miller et al, 2016;Gaspar et al 2018).…”