Radial shortening following a fracture of the proximal radius

Abstract

Background and purpose: The Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short-term outcome in these patients.

Patients and methods: Over an 18-month period, we prospectively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5-12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation.

Results: 60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2-4mm) was seen in 22 patients (mean age 48 (19-79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were managed nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury.

Interpretation: The incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases.

Figure 1.

An Essex-Lopresti lesion was diagnosed in this patient's radiographs, which demonstrated greater than 2 mm of shortening of the ipsilateral radius when compared to the contralateral side.

Figure 2.

Initial presentation AP and lateral radiographs of a 27-year-old male who sustained a Mason type-I fracture of the left elbow while playing sport. An Essex-Lopresti lesion was diagnosed at 2 weeks when bilateral wrist radiographs were taken. Management was conservative, using collar and cuff immobilization for 1 week followed by supervised physiotherapy. At 6 months, the patient had a flexion arc of 152 degrees and a forearm rotation arc of 180 degrees, with an excellent MES (100).