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Essex Lopresti Fracture
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Contents
Other Names
- Essex Lopresti fracture-dislocation
- Essex-Lopresti Injury
- Longitudinal Radioulnar Dissociation
Background
- Triad: Radial Head Fracture combined with Distal Radioulnar Joint Dislocation and rupture of Interosseous Membrane of Forearm
- Named after Peter Gordon Essex-Lopresti, a British trauma surgeon[1]
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
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
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
- DRUJ Compression Test: most sensitive test to diagnose injury (need citation)
- 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
- Migration and subluxation of radial head
- Radiocapitellar Arthritis
- Chronic Pain
- Acute Compartment Syndrome
See Also
- Internal
- External
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ W. G. PETER GORDON ESSEX-LOPRESTI (1916-1951). J Bone Joint Surg Br. 1951;33-B (3): 453-453. J Bone Joint Surg Br
- ↑ Matson, Andrew P., and David S. Ruch. "Management of the Essex-Lopresti injury." Journal of wrist surgery 5.03 (2016): 172-178.
- ↑ 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.
- ↑ 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.
- ↑ 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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