Essex-Lopresti fracture

Description

An Essex-Lopresti injury consists of the classic triad radial head fracture with dislocation of the distal radioulnar joint (DRUJ) and disruption of the interosseous membrane (IOM)

Current surgical treatment of this injury consists of open reduction internal fixation or replacement of the radial head and stabilization of the DRUJ.

1930 – Brockman two cases of disability at the wrist-joint following excision of the head of the radius. [1931; 24(7): 904–905]

1946 – Curr and Coe reported the first documented case of an Essex-Lopresti injury. The patient suffered a radial head fracture and concomitant dislocation of the DRUJ in a mining accident. His arm was caught between two mining hutches causing swelling and limited movement at the elbow, forearm, and wrist. The hand was radially deviated, and the DRUJ was dislocated. The patient complained of severe pain and had gross swelling of the whole forearm, which they ascribed to tearing of the interosseous membrane. [Br J Surg. 1946]

Treated with traction, closed reduction and immobilisation. Resulted in good elbow and wrist movement but pronation and supination limited to 5 degrees.

1951 – Peter Essex-Lopresti (1916-1951) reported two cases. He noted that:

• this was a rare injury but suggested that DRUJ integrity must be inspected when a radial head fracture is present;
• that radial head fracture and DRUJ dislocation were associated with IOM disruption;
• excision of the radial head should be avoided and ORIF should be employed
• in cases with severe comminution, a prosthesis could be used to replace the radial head

1999 – Failla uses ultrasound to effectively diagnose and locate torn interosseous membranes in forearm fracture/dislocations.

Associated Persons

• Peter Gordon Lawrence Essex-Lopresti (1916-1951)

References

Original Articles

• Brockman EP. Two Cases of Disability at the Wrist-joint following Excision of the Head of the Radius. Proc R Soc Med. 1931 May;24(7):904-5
• Curr JF, Coe WA. Dislocation of the inferior radio-ulnar joint. Br J Surg. 1946 Jul;34:74-7
• Essex-Lopresti P. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br. 1951 May;33B(2):244-7.

Review articles

• McGlinn EP, Sebastin SJ, Chung KS. A Historical Perspective on the Essex-Lopresti Injury. J Hand Surg Am. 2013 Aug; 38(8): 1599–1606
• Wegmann K, Dargel J, Burkhart KJ, Brüggemann GP, Müller LP. The Essex-Lopresti lesion. Strategies Trauma Limb Reconstr. 2012 Nov; 7(3): 131–139
• van Riet RP, van Glabbeek F. History of radial head prosthesis in traumatology. Acta Orthop Belg. 2007 Feb;73(1):12-20
• Failla JM, Jacobson J, van Holsbeeck M. Ultrasound diagnosis and surgical pathology of the torn interosseous membrane in forearm fractures/dislocations. J Hand Surg Am. 1999 Mar;24(2):257-66