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. 2016 Aug;5(3):172-8.
doi: 10.1055/s-0036-1584544. Epub 2016 Jun 20.

Management of the Essex-Lopresti Injury

Andrew P Matson  1 , David S Ruch  1
Affiliations

Management of the Essex-Lopresti Injury

Andrew P Matson et al. J Wrist Surg. 2016 Aug.

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.

Keywords: Essex-Lopresti injury; central band; forearm instability; interosseous membrane; pronator rerouting.

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Conflict of interest statement

Conflict of Interest None.

Figures

Fig. 1
Fig. 1
(A) Standard incisions for radial head replacement and ulnar shortening osteotomy. (B) Pronator teres graft incision. (Reproduced with permission from Chloros et al.46)
Fig. 2
Fig. 2
Surgical exposure of the pronator teres. BR, brachioradialis; RN, radial nerve; PT, pronator teres. (Reproduced with permission from Chloros et al.46)
Fig. 3
Fig. 3
(A) In most cases, adequate negative ulnar variance (goal 2 mm) is not achieved by reconstructing the radial head alone, and an ulnar shortening osteotomy fixed with a limited contact dynamic compression plate (LC-DCP) is performed. (B) Corresponding radiograph. (Reproduced with permission from Chloros et al.46)
Fig. 4
Fig. 4
Principle of IOM reconstruction using a pronator teres graft. (Reproduced with permission from Chloros et al.46)
Fig. 5
Fig. 5
(A and B) After removal of the plate, healing of the pronator teres tendon graft to the periosteum of the ulna is observed 2 years after the reconstruction. (Reproduced with permission from Chloros et al.46)
See this image and copyright information in PMC

References

    1. Brockman E P. Two cases of disability at the wrist following excision of the head of the radius. Proc R Soc Med. 1931;24(7):904–905. - PMC - PubMed
    1. Curr J F, Coe W A. Dislocation of the inferior radio-ulnar joint. Br J Surg. 1946;34(133):74–77. - PubMed
    1. Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br. 1951;33B(2):244–247. - PubMed
    1. Helmerhorst G T, Ring D. Subtle Essex-Lopresti lesions: report of 2 cases. J Hand Surg Am. 2009;34(3):436–438. - PubMed
    1. Rodriguez-Martin J, Pretell-Mazzini J, Vidal-Bujanda C. Unusual pattern of Essex-Lopresti injury with negative plain radiographs of the wrist: a case report and literature review. Hand Surg. 2010;15(1):41–45. - PubMed