Abstract
Introduction
What result can one expect in treating an Essex-Lopresti lesion—a rare complex combination injury of the forearm consisting of a radial head fracture and a rupture of the interosseous membrane—which failed to be identified at first?
Materials and methods
We report on a 45-year-old poly traumatized patient in which a primary Essex-Lopresti injury was overlooked following a dislocated radial head fracture. A radial head resection followed by an ulna-shortening osteotomy was performed with disastrous consequences at another clinic. As a result of persistent instability in the distal radioulnar joint, we implanted a mono-polar radial head prosthesis, which was subsequently changed as a result of a loosening of the prosthesis and persistent complex instability and pain in the area of the entire forearm, while an ulna osteotomy had to be carried out to correct this. This prosthesis also loosened, which destroyed the capitulum humeri.
Results
It was only after a specially designed modular radial head prosthesis with a capitulum shield was implanted and an elapse of 5½ years of the illness that permanent stability could be achieved on the forearm and the pain experienced by the patient eliminated while at the same time the patient regained a moderate degree of functioning and grip strength.
Conclusion
An overlooked primary and ultimately initially incorrectly treated Essex-Lopresti injury can degenerate into a real therapeutic disaster.
The result
Years of illness and multiple corrective operations which only serve to limit the collateral damage caused by the wrong therapy strategy and ultimately only lead to restoration of moderate function. The crucial factor is an early diagnosis. Then a radial head prosthesis should first be implanted in an operation in order to prevent an additional proximal migration of the radius and to move the distal radioulnar joint into the proper anatomical position.
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References
Curr JF, Moe WA (1946) Dislocation of the inferior radioulnar joint. Br J Surg 34:74–77
Daecke W, Martini AK (2004) Secondary treatment for Essex-Lopresti lesion. Z Orthop 142:235–240
Doser A, Markmiller M, Strohm PC, Sudkamp NP (2006) Diagnosis and treatment of the Essex-Lopresti Lesion. Literature review and four case reports. Unfallchirurg 109(7):593–599
Edwards GS Jr, Jupiter JB (1988) Radial head fractures with acute distal radioulnar dislocation. Essex Lopresti revisited. Clin Orthop 234:61–69
Essex-Lopresti P. Fractures of the radial head with radio-ulnar dislocation (1951) Report of two cases. J Bone Joint Surg Br 33-B:244–247
Friedman SL, Palmer AK (1991) The ulnar impaction syndrome. Hand Clin 72:295–310
Geel CW, Palmer AK (1992) Radial head fractures and their effect on the distal radioulnar joint. Clin Orthop 275:79–84
Haferkamp H (1994) Die handgelenksnahe radioulnare Arthrodese mit distaler Ellenresektion nach Kapandji. Handchir Mikrochir Plast Chir 26:313–318 (in German)
Hotchkiss RN (1994) Injuries to the interosseous ligament of the forearm. Hand Clin 10(3):391–398
Kapandji JA (1986) Operation de Kapandji-Sauvé. Technique et indications dans les affections non-rhumatismale. Ann Chir Main 5:181–193
Karlstad R, Morrey BF, Cooney WP (2005) Failure of fresh-frozen radial head allografts in the treatment of essex-lopresti injury. A report of four cases. J Bone Joint Sur Am 87:1828–1833
Morrey BF, Chao EY, Hui FC (1979) Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am 61-A:63–68
Neuber M, Joist A, Joosten U, Rieger H (2000) Consequences and possible treatment of distal radio-ulnar dislocation after Essex-Lopresti lesion. Unfallchirurg 103:1093–1096 (in German)
Peterson CA, Maki S, Wood MB (1995) Clinical results of the one-bone forearm. J Hand Surg Am 20:609–618
Rabinowitz RS, Light TR, Havey RM, Gourineni P, Patwardhan AG, Sartori MJ, Vrbos L (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg (Am) 19-A:385–393
Skahen JR, Palmer AK, Werner FW, Fortino MD (1997) The interosseus membrane of the forearm: anatomy and function. J Hand Surg 22-A:981–985
Sowa DT, Hotchkiss RN, Weiland AJ (1995) Symptomatic proximal translation of the radius following radial head resection. Clin Orthop 317:106–113
Stephen IBM (1981) Excision of the radial head for closed fracture. Acta Orthop Scand 52:409–412
Szabo RM, Hotchkiss RN, Slater RR Jr (1997) The use of frozen-allograft radial head replacement for treatment of established symptomatic proximal translation of the radius: preliminary experience in five cases. J Hand Surg Am 22(2):269–278
Tomaino MM, Pfaeffle J, Stabile K, Li ZM (2003) Reconstruction of the interosseus ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg Br 28(3):267–270
Trousdale RT, Amadio PC, Cooney WP, Morrey BF (1992) Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 74-A:1486–1497
van Schoonhoven J, Prommersberger KJ (2000) Differential diagnosis and therapy of post-traumatic limited forearm rotation. Handchir Microchir Plast Chir 32:390–398 (in German)
Zilch H, Kauschke T (1996) The Sauvé-Kapandji procedure for posttraumatic disturbance of the distal radio-ulnar joint with painful and restricted forearm rotation. Unfallchirurg 99:841–844 (in German)
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We declare that the experiments comply with the current german laws.
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Jungbluth, P., Frangen, T.M., Muhr, G. et al. A primarily overlooked and incorrectly treated Essex-Lopresti injury: what can this lead to?. Arch Orthop Trauma Surg 128, 89–95 (2008). https://doi.org/10.1007/s00402-007-0431-7
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DOI: https://doi.org/10.1007/s00402-007-0431-7