The sequelae of a missed Essex-Lopresti lesion

Thomason, K.; Burkhart, Klaus J.; Wegmann, Kilian; Müller, Lars Peter

doi:10.1007/s11751-013-0153-z

Cited by 9 publications

(6 citation statements)

References 17 publications

(17 reference statements)

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“…The management of these injuries remains controversial because there is no clearly defined strategy for the same. 12 The radial head fractures are usually managed with internal fixation using headless screws and mini-plates or radial head excision or replacement based on the reconstructability of the head. The DRUJ can be stabilized in the acute setting, with a transradioulnar Kirschner wire or a suspensory fixation technique.…”

Section: Discussionmentioning

confidence: 99%

Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion

Kaul

Sood²,

Akhoon³

2022

JAAOS Glob Res Rev

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The Essex-Lopresti lesion is a challenging injury both for diagnosis and management. These often tend to be missed, resulting in incapacitating pain and joint stiffness despite treatment. In rare circumstances, they may occur in association with other injuries of the forearm or elbow. We describe an atypical Essex-Lopresti variant comprising a radial head and shaft fracture with an associated distal radioulnar joint dislocation in a 36-year-old man.T he classic Essex-Lopresti lesion, which comprises a fracture of the radial head, disruption of the interosseous membrane, and a dislocation of the distal radioulnar joint (DRUJ), was first introduced by Curr and Coe 1 in 1946 and later described and named after Peter Essex-Lopresti 2 in 1951. Another eponymous fracture, named after Italian surgeon, Riccardo Galeazzi, 3,4 comprises a fracture of the radial shaft along with disruption of the DRUJ. The mechanism of injury in both these injuries is similar, primarily, an axially directed force along the long axis of the forearm, which results in a traumatic dislocation of the DRUJ, disruption of the interosseous membrane, and with continued force, a compression type fracture or dislocation of the radial head. A few rare variants of the abovementioned patterns have been described in the literature, although the combination of a Galeazzi fracture and an Essex-Lopresti lesion has been reported only twice. We report a distinct and rare variant of the abovementioned combination which comprised a concomitant radial head and shaft fracture along with a DRUJ dislocation.

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Section: Discussionmentioning

confidence: 99%

Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion

Kaul

Sood²,

Akhoon³

2022

JAAOS Glob Res Rev

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“…Galeazzi) can be initially misdiagnosed radiographically up to 1 month ( Figures 7A-F), and additionally, only 20% of the Essex-Lopresti injury are fully recognized at time of initial presentation, and initial radiographs are often unremarkable that often results in undertreatment in the acute stage [27,[31][32][33][34][35]. It has also been reported that in case of a radial head fracture associated with an initially misdiagnosed Essex-Lopresti injury, primarily treated by ORIF and followed secondarily (6 months later) by radial head resection due to painful degeneration of the radial head, the proximal radial migration as result of the primarily misdiagnosed Essex-Lopresti injury could only been assessed 1 month after the radial head resection [36]. In contrast to the acute traumatic DRUJ dislocation injury, the EssexLopresti injury is primarily associated with a longitudinal radioulnar instability only whereas (sub)luxation in the lateral plane mostly occurs secondarily [24,[34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…It has also been reported that in case of a radial head fracture associated with an initially misdiagnosed Essex-Lopresti injury, primarily treated by ORIF and followed secondarily (6 months later) by radial head resection due to painful degeneration of the radial head, the proximal radial migration as result of the primarily misdiagnosed Essex-Lopresti injury could only been assessed 1 month after the radial head resection [36]. In contrast to the acute traumatic DRUJ dislocation injury, the EssexLopresti injury is primarily associated with a longitudinal radioulnar instability only whereas (sub)luxation in the lateral plane mostly occurs secondarily [24,[34][35][36][37]. However, in every instance in which an EssexLopresti is suggested, based on radiographic signs of a longitudinal instability in DRUJ, preexisting posttraumatic or degenerative changes which can be responsible for DRUJ instability must be clearly assessed to avoid an overtreatment ( Figures 8A-B).…”

Section: Discussionmentioning

confidence: 99%

“…UPV) [31][32][33][34][35][36][37]55]. In every instance as well when evident DRUJ instability after closed or open reduction of traumatic DRUJ luxation in case of a Galeazzi injury ( Figures 8A-F), greater arc injury, acute isolated DRUJ dislocation injury, or Essex-Lopresti injury persists, radioulnar transfixation using Kirschner-wires is absolutely required to provide DRUJ stability as well as to give the IOM the chance for spontaneous healing [21,27,[31][32][33][34][35][36][37]55]. If a closed DRUJ reduction is unsuccessful due to soft tissue interposition such as the extensor digiti minimi tendon or the traumatically detached TFCC, the open reduction becomes necessary ( Figures 8A-F) [27].…”

Section: Discussionmentioning

confidence: 99%

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Who introduced the "quadrangular-construct" modification of the Sauvé Kapandji procedure first? Case presentation and brief overview of literature with regard to general, specific and practicable aspects to primary trauma-related surgical treatment including possible salvage options at the distal radioulnar joint

Schmidt¹,

Schmitz²,

Muradyan³

et al. 2017

Trauma Emerg Care

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A 26-year-old male sustained a left wrist injury after an occupational fall from height that was diagnosed as wrist sprain and treated conservatively by a plaster splint in another institution. Eight weeks after injury, the patient could be re-employed in his original occupation as a truck driver. Six years after injury, the patient came in our institution for the first time, and reported increasing pain in his left wrist accompanied with marked restriction of his left forearm's supination and pronation leading to the non-ability to carry out his occupational job 8 weeks previously. On clinical examination, there was pronounced dorsal subluxation of the ulnar head without any given possibilities for it manual closed reduction (i.e. static instability in transverse plane) ( Figure 1A). Posterior-anterior (PA) radiographs of both wrists showed no concomitant ulnar positiv variance (UPV) (i.e. no longitudinal instability) and no posttraumatic arthritic changes in the distal radioulnar joint (DRUJ), but the configuration of the ulnar styloid at the formerly injured left wrist could not be well assessed that suggested an additional rotation deformity of the ulnar head ( Figure 1B). Lateral radiographs of both wrist showed marked fixed subluxation of the ulnar head in dorsal direction (i.e. static instability in transverse plane) ( Figure 1C). Due to these findings, the Sauvé-Kapandji procedure, modified by creating a "quadrangularconstruct", was detected by us. At the preoperative radiographs of the left elbow in both planes there were no signs of any pre-existing degenerative changes with specific regard to the radiocapitellar joint.Intraoperatively, first, the 2 cm long ulna segment was excised typically proximal to the DRUJ, then a Kirschner-wire was drilled into the ulnar head parallel to the plane of the operation table on which the left forearm was positioned at terminal range of pronation (i.e. 90°) ( Figure 2A). After that, the ulnar head was rotated 90° perpendicular to the operation table's plane in dorsal direction using the formerly drilled Kirschner-wire, and so the neutral position of DRUJ could be achieved in which the arthrodesis had to be performed ( Figure 2B). Then, the cartilage of both corresponding surfaces in DRUJ was excised, and the DRUJ arthrodesis in neutral position was carried out using a 3.5 mm titanium malleolar screw, and the Kirschner-wire was removed. The next step included the several years later introduced "quadrangularconstruct" modification of the original Sauvé-Kapandji procedure: After decorticalization of the corresponding radius and ulna shafts proximal to the DRUJ arthrodesis and distal to resection plane of the ulna segment, the formerly excised ulna segment has been inserted transversely between both forearm bones and fixated with a second 3.5 mm titanium cortical screw through the ulna segment graft, and finally, complete restoration of rotation motion arc could be achieved ( Figures 2C-D). The correctly performed surgical procedure was confirmed intraoperatively by flu...

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“…In order to find a therapeutic approach for this complex situation, we searched the literature, which unfortunately only recommends the creation of a one-bone forearm [ 16 , 17 , 18 ] to salvage this complex situation.…”

Section: Methodsmentioning

confidence: 99%

Missed Essex-Lopresti Injury—Development of a Combined Proximal and Distal Radio-Ulnar Joint Prosthesis as a Treatment Option and Proof of Concept

2023

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Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the distal radio-ulnar joint, and the interosseous membrane. This can lead to osteoarthritis, impaction syndrome, or instability. If all three structures are injured and lead to instability, the situation is almost unmanageable and many times ends in a one-bone forearm. In this article, we demonstrate a new way to reconstruct the proximal and distal radio-ulnar joint with two patient-specific coupled prostheses. These have been developed with the biomechanical conditions of the forearm in mind, where there are very large forces between the bones. As a result, we are able to present a patient previously severely restricted in the use of his hand and arm via a splint that compressed the forearm, who is now able to perform everyday activities and even light sports, such as badminton, without pain.

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The sequelae of a missed Essex-Lopresti lesion

Cited by 9 publications

References 17 publications

Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion

Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion

Missed Essex-Lopresti Injury—Development of a Combined Proximal and Distal Radio-Ulnar Joint Prosthesis as a Treatment Option and Proof of Concept

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