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Essex Lopresti Fracture

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Other Names

  • Essex Lopresti fracture-dislocation
  • Essex-Lopresti Injury
  • Longitudinal Radioulnar Dissociation

Background


Pathophysiology

  • Compressive load to forearm with extended elbow
  • Rupture of interosseus membrane as a result of axial force transmitted from Radius to Ulna
  • Subsequently, there is axial and longitudinal instability of forearm[2]

Mechanism

  • Usually involves fall from height
  • High energy trauma

Associated Injuries


Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Exam Forearm
  • History
    • Patient will describe a history of trauma or fall
    • Will report both elbow and wrist pain
  • Physical
    • Unstable, painful forearm
    • Painful grip, trouble with pronation
    • Ulnar sided wrist tenderness, radial sided elbow tenderness
  • Special Test
  • Delayed Presentation
    • Extent of injury frequently not recognized acutely
    • Chronic patients may present with lateral elbow pain, ulnar sided wrist pain

Evaluation

Radiographs

  • Standard Radiographs Wrist
  • Standard 2 view forearm as well as elbow, wrist views
  • Note: Can be normal on initial radiographs and easily missed
  • Lateral view may show dorsally subluxed ulna
  • Consider contralateral films to compare ulnar variance

US

  • Can be used to detect rupture of interosseous membrane[3]

MRI

  • Useful to evaluate integrity of interosseous membrane[4]

Classification

  • Based upon severity of radial head fracture
  • Type I: large fragments
  • Type II: comminuted
  • Type III: chronic injury with proximal migration of the radial head

Management

  • Estimated that only 20% are fully recognized at time of initial presentation[5]
  • Diagnosis acutely can be challenging and requires a high index of suspicion
  • Patients diagnosed acutely have better outcomes than those diagnosed in a delayed fashion

Nonoperative

  • This is considered a surgical injury

Operative

  • Technique
    • Radial head repair
    • Interosseus membrane repair
    • Stabilization of DRUJ

Return to Play

  • Highly variable, at discretion of surgeon
  • Little research to guide management

Complications


See Also


References

  1. W. G. PETER GORDON ESSEX-LOPRESTI (1916-1951). J Bone Joint Surg Br. 1951;33-B (3): 453-453. J Bone Joint Surg Br
  2. Matson, Andrew P., and David S. Ruch. "Management of the Essex-Lopresti injury." Journal of wrist surgery 5.03 (2016): 172-178.
  3. Failla J M, Jacobson J, van Holsbeeck M. Ultrasound diagnosis and surgical pathology of the torn interosseous membrane in forearm fractures/dislocations. J Hand Surg Am. 1999;24(2):257–266.
  4. Fester E W, Murray P M, Sanders T G, Ingari J V, Leyendecker J, Leis H L. The efficacy of magnetic resonance imaging and ultrasound in detecting disruptions of the forearm interosseous membrane: a cadaver study. J Hand Surg Am. 2002;27(3):418–424.
  5. Trousdale R T, Amadio P C, Cooney W P, Morrey B F. Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am. 1992;74(10):1486–1497.
Created by:
John Kiel on 13 November 2019 15:22:16
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Last edited:
13 October 2022 21:43:56
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