Chronic Essex-Lopresti injuries: an alternative treatment method.
BACKGROUND
Currently, no technique has met general acceptance for the restoration of forearm longitudinal stability in chronic Essex-Lopresti injuries. The purpose of this study is to present an alternative treatment method for chronic Essex-Lopresti lesions by radial head replacement and ulnar shortening osteotomy.


METHODS
Seven patients with a mean age of 42.4 years were included in the study. Five patients had a staged approach, and 2 underwent both procedures simultaneously. The pain level was assessed with the use of a visual analog scale. Elbow, forearm, and wrist range of motion was evaluated. The Mayo Elbow Performance Score and Mayo Wrist Score were used to assess the postoperative outcomes.


RESULTS
The mean follow-up time was 33 months. The mean pain level was reduced from 8.4 points preoperatively to 3.3 points postoperatively (P < .05). The elbow arc of motion was increased on average from 79° preoperatively to 121° postoperatively (P < .05). Forearm rotation improved from 76° preoperatively to 119° postoperatively (P < .05). The wrist arc of motion improved from 94° preoperatively to 114° postoperatively (P < .05). The mean postoperative Mayo Elbow Performance Score and Mayo Wrist Score were 82 points and 71 points, respectively. The mean ulnar variance was reduced from +8 mm to +3.5 mm postoperatively.


CONCLUSIONS
This study shows that radial head replacement in combination with ulnar shortening osteotomy can be used as an alternative reconstructive procedure in the case of a complex chronic Essex-Lopresti injury. This combination of known procedures yields predictable and satisfactory outcomes and a low complication rate.


METHODS
Level IV, case series, treatment study.
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA, USA.
Aaron I
AI
Venouziou
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA, USA.
Loukia K
LK
Papatheodorou
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA, USA.
Robert W
RW
Weiser
Department of Orthopaedic Surgery, University of Pittsburgh, Orthopaedic Specialists-UPMC, Pittsburgh, PA, USA. Electronic address: dsoterea@hotmail.com.
Dean G
DG
Sotereanos
D000328:Adult; D002908:Chronic Disease; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D005543:Forearm Injuries / Q000601:surgery*; D018460:Fractures, Comminuted / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome; D014457:Ulna / Q000293:injuries / Q000601:surgery*; D014954:Wrist Injuries / Q000601:surgery*; D000092464:Elbow Injuries
Elbow; Essex-Lopresti; forearm; instability; osteotomy; radial head replacement