Essex-Lopresti fracture-dislocation is characterized by a fracture of the radial head, dislocation of the distal radioulnar joint and rupture of the antebrachial interosseous membrane 3.
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Epidemiology
As little as 20% of Essex-Lopresti fracture-dislocations are recognized at the time of initial presentation 6.
Clinical presentation
The injury occurs due to the compressive force of trauma transmitted down the forearm through the proximal and distal radioulnar joints and the interosseous membrane 3,4. This usually occurs from a fall or high-energy trauma with the elbow extended 4. As a result, there is axial and longitudinal loading that causes pain and instability. The distal radioulnar joint injury may be missed, leading to permanent wrist pain, stiffness, or instability. Radiocapitellar impingement due to longitudinal instability may cause lateral elbow pain 4.
Classification
The Edwards and Jupiter classification was proposed in 1988 8:
type I: large displaced radial head fragments with minimal or no comminution and amenable to ORIF
type II: severe comminution requiring radial head excision and prosthetic replacement
type III: old injuries with irreducible proximal migration of the radius managed by ulnar shortening and radial head prosthetic replacement
Pathology
Rupture of the interosseous membrane results in perturbed transmission of force from the radius to the ulna 7. If not recognized acutely, chronic instability and proximal migration of the radius results in ulna abutment with increased force transmission across the ulnocarpal joint 4.
Radiographic features
Initial radiographs may be unremarkable for Essex-Lopresti fracture-dislocations 6.
Treatment and prognosis
There have been historically poor outcomes in the treatment of longitudinal forearm instability which is particularly complex in the chronic setting 3. The low incidence, late presentations and heterogeneity in study samples presented in the literature preclude researchers reaching safe conclusions and planning of clinical studies 3. A study found that radial head replacement with the reconstruction of the interosseous membranes and central band restores radioulnar displacement and ulna forces to near normal 3.
History and etymology
It is named after Peter Gordon Essex-Lopresti (1916-1951), a trauma surgeon at Birmingham Accident Hospital, England 2.
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