title: The treatment of the acute Essex-Lopresti injury.
abstract: The Essex-Lopresti injury (ELI) of the forearm is a rare and serious condition which is often overlooked, leading to a poor outcome. The purpose of this retrospective case study was to establish whether early surgery can give good medium-term results. From a group of 295 patients with a fracture of the radial head, 12 patients were diagnosed with ELI on MRI which confirmed injury to the interosseous membrane (IOM) and ligament (IOL). They were treated by reduction and temporary Kirschner (K)-wire stabilisation of the distal radioulnar joint (DRUJ). In addition, eight patients had a radial head replacement, and two a radial head reconstruction. All patients were examined clinically and radiologically 59 months (25 to 90) after surgery when the mean Mayo Modified Wrist Score (MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores (MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome. In case of a high index of suspicion for ELI in patients with a radial head fracture, we recommend the following: confirmation of IOM and IOL injury with an early MRI scan; early surgery with reduction and temporary K-wire stabilisation of the DRUJ; preservation of the radial head if at all possible or replacement if not, and functional bracing in supination. This will increase the prospect of a good result, and avoid the complications of a missed diagnosis and the difficulties of late treatment.
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: J P
authors.initials: JP
authors.lastname: Grassmann
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hakimi
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: S V
authors.initials: SV
authors.lastname: Gehrmann
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Betsch
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Kröpil
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wild
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Windolf
authors.affiliation: University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Jungbluth
mesh_terms: D000208:Acute Disease; D000328:Adult; D001864:Bone Wires; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005543:Forearm Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D018737:Hand Strength; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011885:Radius Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology; D000092464:Elbow Injuries
keywords: Acute Essex-lopresti injury; Distal radioulnar joint; Interossseous membrane; Radial head prosthesis; Temporary K-wire arthrodesis