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. 2020 Apr;12(1):47-55.
doi: 10.1055/s-0039-3401380. Epub 2020 Jan 16.

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

Svenna H W L Verhiel  1 , Sezai Özkan  1 , Christopher G Langhammer  1 , Neal C Chen  1
Affiliations

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

Svenna H W L Verhiel et al. J Hand Microsurg. 2020 Apr.

Abstract

Objective The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0-12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33-38). Median NRS score for pain-severity on average was 5 (IQR: 0-6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5-8). Conclusion Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

Keywords: Essex-Lopresti; distal radioulnar joint disruption; interosseous membrane rupture; longitudinal forearm dissociation.

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Conflict of interest statement

Ethical ApprovalConflict of Interest The Institutional Review Board of our institution approved this study under protocol no. 1999P008705. None declared.

Figures

Fig. 1
Fig. 1
Radiographs of the wrist ([A] posteroanterior, [B] lateral) at day of presentation, with evident widening of distal radioulnar joint and dorsal subluxation on the ulna.
Fig. 2
Fig. 2
Radiographs of the wrist ([A] posteroanterior, [B] lateral) after distal radioulnar joint fusion with iliac crest bone graft.
See this image and copyright information in PMC

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