Essex-Lopresti fracture

Description

An Essex-Lopresti injury consists of a 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.


History

1930 – Brockman reported on 2 cases of radial head fractures associated with proximal migration of the radius. [1931 May; 24(7): 904–905]

1946 – Curr and Coe reported on a patient with a radial head fracture and concomitant dislocation of the DRUJ. [Br J Surg. 1946 Jul;34:74-7] Mining accident with arm 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. Treated with traction, closed reduction and immobilisation. Resulted in good elbow and wrist movement but pronation and supination limited to 5 degrees.

1951Essex-Lopresti 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


References

  • 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. [PMC2182896]
  • Curr JF, Coe WA. Dislocation of the inferior radio-ulnar joint. Br J Surg. 1946 Jul;34:74-7. [PMID 20994136]
  • 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. [PMID 14832324] [Full Text]
  • McGlinn EP, Sebastin SJ, Chung KS. A Historical Perspective on the Essex-Lopresti Injury. J Hand Surg Am. 2013 Aug; 38(8): 1599–1606. [PMC4157731]
  • Wegmann K, Dargel J, Burkhart KJ, Brüggemann GP, Müller LP. The Essex-Lopresti lesion. Strategies Trauma Limb Reconstr. 2012 Nov; 7(3): 131–139. [PMC3482440]
  • van Riet RP, van Glabbeek F. History of radial head prosthesis in traumatology. Acta Orthop Belg. 2007 Feb;73(1):12-20. [PMID 17441652]
  • 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. [PMID 10194008]

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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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