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

Abstract

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.