The Essex-Lopresti Injury: A Variation

1988 ◽  
Vol 13 (4) ◽  
pp. 450-452
Author(s):  
E. J. HARGADON ◽  
M. L. PORTER
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Fracture Dislocation ◽  
Essex Lopresti

The Essex-Lopresti fracture-dislocation consists of a radial head fracture associated with dislocation of the inferior radio-ulnar joint. We report a variation of this injury in which there was an additional fracture through the scaphoid.

scholarly journals Irreducible anteromedial radial head fracture-dislocation: value of pre-operative magnetic resonance imaging

2020 ◽  
pp. 20200111
Author(s):  
Lee Kai Lim ◽  
Joey Beh
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Rare Condition ◽  
Fracture Dislocation ◽  
Imaging Findings ◽  
Mri Imaging ◽  
Resonance Imaging ◽  
Rare Presentation ◽  
Sustained Reduction ◽  
Surgical Journal

We describe a case of an anteromedial fracture-dislocation of the radial head in an adult patient, which was initially irreducible using closed means, and remained challenging to reduce despite open surgery. Further advanced CT/MRI revealed entrapment of the radial head due to the interposition of the brachialis tendon posteriorly, thereby preventing sustained reduction. While three other cases of irreducible anteromedial radial head dislocation due to the brachialis tendon have been reported in the English surgical literature, none of the imaging findings have been described in the radiological literature. Only one other case published in a surgical journal briefly demonstrated pre-operative MRI imaging. We would like to share the value of pre-operative MRI in this rare presentation, which would be helpful in diagnosing not only cases with interposition of the brachialis tendon, but potentially other types of soft tissue interposition which also limit closed reduction. To the best of the authors’ knowledge, this would be the first report on the imaging findings in a radiological journal. Awareness of this phenomenon would assist radiologists in the diagnosis and management of this rare condition.

scholarly journals THE SURGICAL TREATMENT OF HEAD RADIAL BONE FRACTURE IV TYPE BY MASON-HOTCHKISS FOR THE IMPLEMENTATION OF THE CEMENTLESS BIPOLAR MODULAR ENDOPROSTHESIS OF THE HEAD RADIAL BONE

2020 ◽  
Vol 1 (1) ◽  
pp. 51-57
Author(s):  
D. E. Shcherbakov ◽  
V. B. Makarov ◽  
I. V. Boiko ◽  
H. O. Lazarenko
Keyword(s):  
Radial Head ◽  
Evaluation System ◽  
Radial Head Fracture ◽  
Fracture Dislocation ◽  
Type Iv ◽  
Metal Metal ◽  
Bipolar Endoprosthesis ◽  
Modular Endoprosthesis ◽  
Radial Bone ◽  
Metal Friction

Aim. The author of the article shows the features of the surgical technique of implantation of the developed cementless modular bipolar endoprosthesis of the head of the radial bone with a pair of metal-metal friction. Materials and methods. The developed cementless modular bipolar endoprosthesis of the radial head with a pair of metal-metal friction. Indications for endoprosthetic of the head of the radial were the fracture of the head IV, according to Mason-Hotchkiss. The result of the treatment was assessed by the Mayo Elbow Performance Score evaluation system. Results and discussion. At fractures on Mason-Hotchkiss IV type, the endoprosthetic of the head of a radial bone is applied. The use of the developed modular endoprosthesis of the head of the radial made it possible to restore the stability of the elbow joint, to resume rotational movements of the head radial, while maintaining the functional volume of flexion-extensor movements, and also to restore the length of the radial bone. Conclusions. The use of the developed advanced cementless bipolar modular endoprosthesis of radial head fracture-dislocation type IV by Mason-Hotchkiss allowed obtaining a good result, according to the assessment of the MEPS clinic (88.5 scores) in 6 months after surgery.

Patient and Surgeon Factors Associated With Prosthetic Replacement Rather Than With Open Reduction and Internal Fixation of a Radial Head Fracture

Hand ◽  
2020 ◽  
pp. 155894472091835 ◽  
Author(s):  
Casey M. O’Connor ◽  
Joost Kortlever ◽  
Gregg A. Vagner ◽  
Lee M. Reichel ◽  
David Ring
Keyword(s):  
Internal Fixation ◽  
Radial Head ◽  
Open Reduction ◽  
Radial Head Fracture ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Radial Head Arthroplasty ◽  
Factors Associated ◽  
Radial Head Replacement ◽  
Patient Variables

Background: The decision between radial head arthroplasty and open reduction internal fixation in the context of a terrible triad elbow fracture-dislocation is debated. This study investigated both surgeon and patient factors associated with surgeons’ recommendations to use arthroplasty. Methods: One hundred fifty-two surgeon members of the Science of Variation Group participated. Surgeons were asked to complete an online survey that included surgeon demographics and 16 patient scenarios. The patient scenarios were randomized using 2 patient variables and 2 anatomical variables. Multilevel logistic mixed regression analysis was performed to identify surgeon and patient variables associated with recommendations for radial head arthroplasty. Results: We found that radial head replacement was recommended in 38% of the scenarios. Scenarios with older patients, with fractures of the whole head, and those involving 3 fracture fragments were independently associated with radial head replacement. Conclusion: We found that most surgeons recommended radial head fracture fixation rather than arthroplasty. Surgeons were more likely to recommend fixation for younger patients with partial articular fractures or with fractures with 3 or fewer fracture fragments. It seems that surgeons are uneasy about using a prosthesis in a young active patient.

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

2020 ◽  
pp. 1-5
Author(s):  
Raul Barco ◽  
Minotta Quebradas MJ ◽  
Antuña SA ◽  
Raul Barco
Keyword(s):  
Radial Head ◽  
Ligament Reconstruction ◽  
Radial Head Fracture ◽  
Interosseous Membrane ◽  
Surgical Reconstruction ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Radial Head Arthroplasty ◽  
Ulnar Shortening Osteotomy ◽  
Essex Lopresti

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.

The Essex–Lopresti Lesion: A Variant with a Bony Distal Radioulnar Joint Injury

2006 ◽  
Vol 31 (2) ◽  
pp. 206-207 ◽  
Author(s):  
J. AUYEUNG ◽  
G. BROOME
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Soft Tissue Injuries ◽  
Distal Radioulnar Joint ◽  
Joint Injury ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
Ulnar Head ◽  
Proximal Migration ◽  
Essex Lopresti

The Essex–Lopresti lesion is an unusual injury, consisting of a radial head or neck fracture, distal radioulnar joint (DRUJ) injury and interosseous membrane rupture. To date, all reported Essex–Lopresti lesions have consisted of soft tissue injuries at the DRUJ. We present a case of an Essex–Lopresti lesion with a bony variant, in which the DRUJ injury consisted of an ulnar head fracture associated with radial head fracture and acute proximal migration of the radius. The management involved plating of the ulnar head fracture and titanium replacement of the radial head.

Anteromedial radial head fracture-dislocation associated with a transposed biceps tendon: a case report

2011 ◽  
Vol 20 (4) ◽  
pp. e14-e18 ◽  
Author(s):  
Vidyadhar V. Upasani ◽  
Eric R. Hentzen ◽  
Matthew J. Meunier ◽  
Reid A. Abrams
Keyword(s):  
Case Report ◽  
Radial Head ◽  
Radial Head Fracture ◽  
Biceps Tendon ◽  
Fracture Dislocation

scholarly journals Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?

2018 ◽  
Vol 21 (4) ◽  
pp. 234-239
Author(s):  
Hee Seok Yang ◽  
Jeong Woo Kim ◽  
Sung Hyun Lee ◽  
Byung Min Yoo
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Articular Surface ◽  
Fracture Dislocation ◽  
Elbow Fracture ◽  
Group A ◽  
Elbow Fracture Dislocation ◽  
Group B ◽  
Comminuted Radial Head Fracture ◽  
Partial Excision

BACKGROUND: In elbow fracture-dislocation, partial excision of the comminuted radial head fracture that is not amenable to fixation remains controversial considering the accompanying symptoms. This study was undertaken to evaluate the results of radial head partial excision when the comminuted radial head fracture involved < 50% of the articular surface in all-arthroscopic repair of elbow fracture-dislocation.METHODS: Patients were divided into two groups based on the condition of the radial head fracture. In Group A, the patients had a radial head comminuted fracture involving < 50% of the articular surface, and underwent arthroscopic partial excision. Group B was the non-excision group comprising patients with stable and non-displacement fractures. Follow-up consultations were conducted at 6 weeks and at 3, 6, 12, and 24 months after surgery.RESULTS: In all, 19 patients (Group A: 11; Group B: 8) met the inclusion criteria and were enrolled in the study. At the final follow-up, all 19 patients showed complete resolution of elbow instability. No significant differences were observed in the range of motion, visual analogue scale score, and Mayo elbow performance score between groups. Radiological findings did not show any complications of the radiocapitellar joint. However, nonunion of the coracoid fracture was observed in 3 patients (Group A: 1; Group B: 2), without any accompanying instability and clinical symptoms.CONCLUSIONS: Considering that the final outcome is coronoid fracture fixation and lateral collateral ligament complex repair for restoring elbow stability, arthroscopic partial excision for radial head comminuted fractures involving < 50% of articular surface is an effective and acceptable treatment for elbow fracture-dislocation.

UNUSUAL PATTERN OF ESSEX-LOPRESTI INJURY WITH NEGATIVE PLAIN RADIOGRAPHS OF THE WRIST: A CASE REPORT AND LITERATURE REVIEW

Hand Surgery ◽  
2010 ◽  
Vol 15 (01) ◽  
pp. 41-45 ◽  
Author(s):  
Juan Rodriguez-Martin ◽  
Juan Pretell-Mazzini ◽  
Carlos Vidal-Bujanda
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Distal Radioulnar Joint ◽  
Interosseous Membrane ◽  
Radioulnar Joint ◽  
Unusual Pattern ◽  
Radial Neck Fracture ◽  
Radial Neck ◽  
Neck Fracture ◽  
Essex Lopresti

The Essex-Lopresti injury consists of a fracture of the radial head, rupture of the interosseous membrane and disruption of the distal radioulnar joint. The greatest challenge with this injury pattern is the diagnosis, because it is frequently missed and the attention usually focused on the elbow joint. In this paper we report an unusual pattern of Essex-Lopresti injury with a radial neck fracture, a tear of the interosseous membrane and a disruption of the distal radioulnar joint in which initial wrist radiographs did not show significative abnormalities. Open reduction and internal fixation for the radial head fracture was performed. Forearm rotation was locked with two Kirschner wires from ulna to radius to allow interosseous membrane to heal. This case is even more difficult to diagnose than classic Essex-Lopresti pattern because of the absence of radius shortening, due to this specific radius fracture pattern, and also the absence of distal radioulnar joint dislocation. When treating a radial head fracture but also a radial neck fracture, interosseous membrane injury should be suspected to avoid misleading in diagnosis.

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