Forearm Instability

Green, Jennifer B.; Zelouf, David S.

doi:10.1016/j.jhsa.2009.03.018

Cited by 34 publications

(31 citation statements)

References 47 publications

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“…Essex-Lopresti lesions are often suspected following high-energy falls onto an outstretched hand, e.g. a fall from a height (Dodds et al 2008, Green and Zelouf 2009). However, in the literature, a varying degree of force has been said to be required to disrupt the triangular fibrocartilage complex, the interosseous ligament, and to fracture the radial head (Hotchkiss et al 1989, Wallace et al 1997).…”

Section: Discussionmentioning

confidence: 99%

Radial shortening following a fracture of the proximal radius

Duckworth

Watson

Will³

et al. 2011

Acta Orthopaedica

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Background and purposeThe Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short-term outcome in these patients.Patients and methodsOver an 18-month period, we prospectively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5–12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation.Results60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2–4mm) was seen in 22 patients (mean age 48 (19–79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were managed nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury.InterpretationThe incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases.

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Section: Discussionmentioning

confidence: 99%

Radial shortening following a fracture of the proximal radius

Duckworth

Watson

Will³

et al. 2011

Acta Orthopaedica

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“…11 When the IOM is damaged (Essex-Lopresti injury), proximal migration of the radial head occurs, and immobilization of the forearm for at least 6 to 8 weeks is recommended to allow torn ligaments to heal. 5,12 However, there is little evidence in the literature that IOM has the capacity to heal with mechanical integrity after prolonged immobilization, 13 and it is postulated that herniation of the anterior compartment muscles causes separation of the torn edges of an IOM and, thus, prevents anatomical healing.…”

Section: Discussionmentioning

confidence: 99%

Failure of the Interosseous Membrane to Heal With Immobilization, Pinning of the Distal Radioulnar Joint, and Bipolar Radial Head Replacement in a Case of Essex-Lopresti Injury: Case Report

Gong

Chung

et al. 2010

The Journal of Hand Surgery

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“…Today, the cause is still believed to be the application an axial load to a pronated forearm, as during a fall [11, 15, 29]. In 2003, McGinley et al [55] demonstrated that the pattern of injury by an axial load depends on the rotational position of the forearm; with the forearm pronated, the resultant injury may be a fracture of the radial head and lesions to the IM.…”

Section: Trauma Mechanisms Of Essex-lopresti Lesions and The Biomechamentioning

confidence: 99%

“…In addition, injuries to the forearm can have a relevant impact on the wounded individual. In addition to Galeazzi fracture, Monteggia fractures complete forearm fractures and solitary radial head fractures, the Essex-Lopresti injury is a condition of dramatic changes to the structures and the function of the forearm following axial trauma [22, 29, 36, 59]. This combination of radial head fracture, lesions of the interosseous membrane (IM) and lesions of the distal radio-ulnar joint (DRUJ) was first clinically described by Curr and Coe in 1946 [13].…”

Section: Introductionmentioning

confidence: 99%

The Essex-Lopresti lesion

Wegmann¹,

Dargel²,

Burkhart³

et al. 2012

Strategies in Trauma and Limb Reconstruction

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The Essex-Lopresti lesion represents a severe injury of the forearm unit. In the 1940s, it’s pathology and consequences have already been mentioned by several authors. Over the course of time, the pathophysiology of the lesion was displayed in more detail. Therefore, an intensive analysis of the involved anatomic structures was done. The interosseous membrane was shown to play a major role in stabilising the forearm unit, in the situation of a fractured radial head, which is the primary stabiliser of the longitudinal forearm stability. Moreover, biomechanical analyses showed a relevant attribution of the distal radio-ulnar joint to the forearm stability. If, in the case of a full-blown Essex-Lopresti lesion, the radial head, the interosseous membrane and the distal radio-ulnar joint are injured, proximalisation of the radius will take place and will come along with secondary symptoms at the elbow joint and the wrist. According to actual studies, the lesion seems to occur more often than realised up to now. Thus, to avoid missing the complex injury, subtle clinical diagnosis combined with adequate imaging has to be undertaken. If the lesion is confirmed, several operative treatment options are available, yet not proofed to be sufficient.

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Forearm Instability

Cited by 34 publications

References 47 publications

Radial shortening following a fracture of the proximal radius

Radial shortening following a fracture of the proximal radius

Failure of the Interosseous Membrane to Heal With Immobilization, Pinning of the Distal Radioulnar Joint, and Bipolar Radial Head Replacement in a Case of Essex-Lopresti Injury: Case Report

The Essex-Lopresti lesion

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