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

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.

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Short term outcome of radial head arthroplasty in Mason type 3 and 4 fractures

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212431 ◽

2021 ◽

Vol 7 (4) ◽

pp. 830

Author(s):

Mudasir Rashid Ganai ◽

Shahid Shabir Khan ◽

Inayat Rahim ◽

Saheel Maajid ◽

Tahir Ahmed Dar

Keyword(s):

Radial Head ◽

Functional Performance ◽

Radial Head Fracture ◽

Late Complications ◽

Term Outcome ◽

Radial Head Fractures ◽

Radial Head Arthroplasty ◽

Suitable Treatment ◽

Comminuted Radial Head Fracture ◽

Type 3

Background: Radial head arthroplasty provides a suitable treatment in Mason type 3 and 4 3 fractures. Arthroplasty produces consistent results with a shorter learning curve than ORIF and prevents the late complications associated with radial head excision.Methods: After seeking approval from local institutional ethical committee 30 patients with Mason type 3 and 4 radial head fractures were admitted from outpatient department (OPD) of SKIMS MC and Hospital Bemina, Srinagar. The study was conducted from February 2019 to June 2020 in department of Orthopaedics SKIMS MC and Hospital Bemina, Srinagar. 30 patients with mean age of 25 years comprising of 9 females and 21 males underwent radial head arthroplasty and were followed up to a minimum of 1 year post-operatively.Results: Outcome was evaluated by assessing elbow functional performance using Mayo elbow performance (MEPI). No revisions were performed during the study. Two patients had implant backout and 6 patients had elbow stiffness.Conclusions: Radial head arthroplasty can be used successfully with most of excellent results for treatment of comminuted radial head fracture (Mason type III and IV radial head fractures). Over all radial head arthroplasty is a demanding option in type 3 and type 4 fractures which are not amenable to reconstruction.

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

Hand Surgery ◽

10.1142/s0218810410004497 ◽

2010 ◽

Vol 15 (01) ◽

pp. 41-45 ◽

Cited By ~ 9

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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Author Response Regarding “The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction”

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2018.06.018 ◽

2018 ◽

Vol 34 (9) ◽

pp. 2525-2526

Author(s):

Ioannis Karikis ◽

Jüri Kartus

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Author Response ◽

Term Outcome ◽

Long Term Outcome ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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The Essex-Lopresti Injury: A Variation

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681_88_90177-5 ◽

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.

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The Long-Term Outcome of Open Reduction and Internal Fixation of Stable Displaced Isolated Partial Articular Fractures of the Radial Head

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e31818234d6 ◽

2009 ◽

Vol 67 (1) ◽

pp. 143-146 ◽

Cited By ~ 41

Author(s):

Anneluuk L. C. Lindenhovius ◽

Quinten Felsch ◽

David Ring ◽

Peter Kloen

Keyword(s):

Internal Fixation ◽

Radial Head ◽

Open Reduction ◽

Term Outcome ◽

Long Term Outcome ◽

Articular Fractures

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

Journal of Hand and Microsurgery ◽

10.1055/s-0039-3401380 ◽

2020 ◽

Vol 12 (01) ◽

pp. 47-55

Author(s):

Svenna H. W. L. Verhiel ◽

Sezai Özkan ◽

Christopher G. Langhammer ◽

Neal C. Chen

Keyword(s):

Upper Extremity ◽

Radial Head ◽

Rating Scale ◽

Case Series ◽

Outcome Evaluation ◽

Pain Severity ◽

Measurement Information ◽

Radial Head Arthroplasty ◽

Patient Reported ◽

Essex Lopresti

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.

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