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Published in: Strategies in Trauma and Limb Reconstruction 3/2012

Open Access 01-11-2012 | Review

The Essex-Lopresti lesion

Authors: K. Wegmann, J. Dargel, K. J. Burkhart, G. P. Brüggemann, L. P. Müller

Published in: Strategies in Trauma and Limb Reconstruction | Issue 3/2012

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Abstract

The Essex-Lopresti lesion represents a severe injury of the forearm unit. In the 1940s, it’s pathology and consequences have already been mentioned by several authors. Over the course of time, the pathophysiology of the lesion was displayed in more detail. Therefore, an intensive analysis of the involved anatomic structures was done. The interosseous membrane was shown to play a major role in stabilising the forearm unit, in the situation of a fractured radial head, which is the primary stabiliser of the longitudinal forearm stability. Moreover, biomechanical analyses showed a relevant attribution of the distal radio-ulnar joint to the forearm stability. If, in the case of a full-blown Essex-Lopresti lesion, the radial head, the interosseous membrane and the distal radio-ulnar joint are injured, proximalisation of the radius will take place and will come along with secondary symptoms at the elbow joint and the wrist. According to actual studies, the lesion seems to occur more often than realised up to now. Thus, to avoid missing the complex injury, subtle clinical diagnosis combined with adequate imaging has to be undertaken. If the lesion is confirmed, several operative treatment options are available, yet not proofed to be sufficient.
Literature
1.
go back to reference Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27(2):243–251PubMedCrossRef Adams BD, Berger RA (2002) An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 27(2):243–251PubMedCrossRef
2.
go back to reference Adams BD, Divelbiss BJ (2001) Reconstruction of the posttraumatic unstable distal radioulnar joint. Orthop Clin North Am 32(2):353–363 xPubMedCrossRef Adams BD, Divelbiss BJ (2001) Reconstruction of the posttraumatic unstable distal radioulnar joint. Orthop Clin North Am 32(2):353–363 xPubMedCrossRef
4.
go back to reference Almquist EE (1992) Evolution of the distal radioulnar joint. Clin Orthop Relat Res 275:5–13PubMed Almquist EE (1992) Evolution of the distal radioulnar joint. Clin Orthop Relat Res 275:5–13PubMed
8.
go back to reference Burkhart KJ, Mueller LP, Krezdorn D, Appelmann P, Prommersberger KJ, Sternstein W, Rommens PM (2007) Stability of radial head and neck fractures: a biomechanical study of six fixation constructs with consideration of three locking plates. J Hand Surg Am 32(10):1569–1575. doi:10.1016/j.jhsa.2007.08.023PubMedCrossRef Burkhart KJ, Mueller LP, Krezdorn D, Appelmann P, Prommersberger KJ, Sternstein W, Rommens PM (2007) Stability of radial head and neck fractures: a biomechanical study of six fixation constructs with consideration of three locking plates. J Hand Surg Am 32(10):1569–1575. doi:10.​1016/​j.​jhsa.​2007.​08.​023PubMedCrossRef
13.
14.
go back to reference de Araujo W, Poehling GG, Kuzma GR (1996) New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies. Arthroscopy 12(6):699–703PubMedCrossRef de Araujo W, Poehling GG, Kuzma GR (1996) New Tuohy needle technique for triangular fibrocartilage complex repair: preliminary studies. Arthroscopy 12(6):699–703PubMedCrossRef
18.
go back to reference Edwards GS Jr, Jupiter JB (1988) Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 234:61–69PubMed Edwards GS Jr, Jupiter JB (1988) Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 234:61–69PubMed
19.
go back to reference Epner RA, Bowers WH, Guilford WB (1982) Ulnar variance—the effect of wrist positioning and roentgen filming technique. J Hand Surg Am 7(3):298–305PubMedCrossRef Epner RA, Bowers WH, Guilford WB (1982) Ulnar variance—the effect of wrist positioning and roentgen filming technique. J Hand Surg Am 7(3):298–305PubMedCrossRef
21.
go back to reference Esser RD, Davis S, Taavao T (1995) Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma 9(4):318–323PubMedCrossRef Esser RD, Davis S, Taavao T (1995) Fractures of the radial head treated by internal fixation: late results in 26 cases. J Orthop Trauma 9(4):318–323PubMedCrossRef
22.
go back to reference Essex-Lopresti P (1951) Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br 33B(2):244–247PubMed Essex-Lopresti P (1951) Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg Br 33B(2):244–247PubMed
24.
go back to reference Fester EW, Murray PM, Sanders TG, Ingari JV, Leyendecker J, Leis HL (2002) The efficacy of magnetic resonance imaging and ultrasound in detecting disruptions of the forearm interosseous membrane: a cadaver study. J Hand Surg Am 27(3):418–424PubMedCrossRef Fester EW, Murray PM, Sanders TG, Ingari JV, Leyendecker J, Leis HL (2002) The efficacy of magnetic resonance imaging and ultrasound in detecting disruptions of the forearm interosseous membrane: a cadaver study. J Hand Surg Am 27(3):418–424PubMedCrossRef
27.
go back to reference Goldberg I, Peylan J, Yosipovitch Z (1986) Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am 68(5):675–679PubMed Goldberg I, Peylan J, Yosipovitch Z (1986) Late results of excision of the radial head for an isolated closed fracture. J Bone Joint Surg Am 68(5):675–679PubMed
28.
go back to reference Gong HS, Chung MS, Oh JH, Lee YH, Kim SH, Baek GH (2010) Failure of the interosseous membrane to heal with immobilization, pinning of the distal radioulnar joint, and bipolar radial head replacement in a case of Essex-Lopresti injury: case report. J Hand Surg Am 35(6):976–980. doi:10.1016/j.jhsa.2010.03.004PubMedCrossRef Gong HS, Chung MS, Oh JH, Lee YH, Kim SH, Baek GH (2010) Failure of the interosseous membrane to heal with immobilization, pinning of the distal radioulnar joint, and bipolar radial head replacement in a case of Essex-Lopresti injury: case report. J Hand Surg Am 35(6):976–980. doi:10.​1016/​j.​jhsa.​2010.​03.​004PubMedCrossRef
31.
go back to reference Halls AA, Travill A (1964) Transmission of pressures across the elbow joint. Anat Rec 150:243–247PubMedCrossRef Halls AA, Travill A (1964) Transmission of pressures across the elbow joint. Anat Rec 150:243–247PubMedCrossRef
33.
go back to reference Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK (2004) Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am 86-A(9):1925–1930PubMed Herbertsson P, Josefsson PO, Hasserius R, Besjakov J, Nyqvist F, Karlsson MK (2004) Fractures of the radial head and neck treated with radial head excision. J Bone Joint Surg Am 86-A(9):1925–1930PubMed
34.
go back to reference Hotchkiss RN (1997) Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 5(1):1–10PubMed Hotchkiss RN (1997) Displaced fractures of the radial head: internal fixation or excision? J Am Acad Orthop Surg 5(1):1–10PubMed
35.
go back to reference Hotchkiss RN (1994) Injuries to the interosseous ligament of the forearm. Hand Clin 10(3):391–398PubMed Hotchkiss RN (1994) Injuries to the interosseous ligament of the forearm. Hand Clin 10(3):391–398PubMed
36.
go back to reference Hotchkiss RN, An KN, Sowa DT, Basta S, Weiland AJ (1989) An anatomic and mechanical study of the interosseous membrane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg Am 14(2 Pt 1):256–261PubMedCrossRef Hotchkiss RN, An KN, Sowa DT, Basta S, Weiland AJ (1989) An anatomic and mechanical study of the interosseous membrane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg Am 14(2 Pt 1):256–261PubMedCrossRef
38.
go back to reference Jaakkola JI, Riggans DH, Lourie GM, Lang CJ, Elhassan BT, Rosenthal SJ (2001) Ultrasonography for the evaluation of forearm interosseous membrane disruption in a cadaver model. J Hand Surg Am 26(6):1053–1057PubMedCrossRef Jaakkola JI, Riggans DH, Lourie GM, Lang CJ, Elhassan BT, Rosenthal SJ (2001) Ultrasonography for the evaluation of forearm interosseous membrane disruption in a cadaver model. J Hand Surg Am 26(6):1053–1057PubMedCrossRef
39.
go back to reference Jung JM, Baek GH, Kim JH, Lee YH, Chung MS (2001) Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 83(7):1029–1033PubMedCrossRef Jung JM, Baek GH, Kim JH, Lee YH, Chung MS (2001) Changes in ulnar variance in relation to forearm rotation and grip. J Bone Joint Surg Br 83(7):1029–1033PubMedCrossRef
40.
go back to reference Kaas L, van Riet RP, Vroemen JP, Eygendaal D (2008) The incidence of associated fractures of the upper limb in fractures of the radial head. Strateg Trauma Limb Reconstr 3(2):71–74. doi:10.1007/s11751-008-0038-8CrossRef Kaas L, van Riet RP, Vroemen JP, Eygendaal D (2008) The incidence of associated fractures of the upper limb in fractures of the radial head. Strateg Trauma Limb Reconstr 3(2):71–74. doi:10.​1007/​s11751-008-0038-8CrossRef
42.
go back to reference Kam CC, Jones CM, Fennema JL, Latta LL, Ouellette EA, Evans PJ (2010) Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg Am 35(10):1626–1632. doi:10.1016/j.jhsa.2010.07.020PubMedCrossRef Kam CC, Jones CM, Fennema JL, Latta LL, Ouellette EA, Evans PJ (2010) Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg Am 35(10):1626–1632. doi:10.​1016/​j.​jhsa.​2010.​07.​020PubMedCrossRef
43.
go back to reference Kannus P, Jarvinen M (1990) Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med 9(4):244–260PubMedCrossRef Kannus P, Jarvinen M (1990) Nonoperative treatment of acute knee ligament injuries. A review with special reference to indications and methods. Sports Med 9(4):244–260PubMedCrossRef
44.
go back to reference Kapandji A (2001) Biomechanics of pronation and supination of the forearm. Hand Clin 17(1):111–122 viiPubMed Kapandji A (2001) Biomechanics of pronation and supination of the forearm. Hand Clin 17(1):111–122 viiPubMed
45.
48.
go back to reference Knight DJ, Rymaszewski LA, Amis AA, Miller JH (1993) Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 75(4):572–576PubMed Knight DJ, Rymaszewski LA, Amis AA, Miller JH (1993) Primary replacement of the fractured radial head with a metal prosthesis. J Bone Joint Surg Br 75(4):572–576PubMed
49.
go back to reference Koslowsky TC, Mader K, Gausepohl T, Pennig D (2007) Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1–4 years. Acta Orthop 78(1):151–156. doi:10.1080/17453670610013565PubMedCrossRef Koslowsky TC, Mader K, Gausepohl T, Pennig D (2007) Reconstruction of Mason type-III and type-IV radial head fractures with a new fixation device: 23 patients followed 1–4 years. Acta Orthop 78(1):151–156. doi:10.​1080/​1745367061001356​5PubMedCrossRef
50.
go back to reference Lee SJ, Jazrawi LM, Ong BC, Raskin KB (2000) Long-term follow-up of the one-bone forearm procedure. Am J Orthop 29(12):969–972PubMed Lee SJ, Jazrawi LM, Ong BC, Raskin KB (2000) Long-term follow-up of the one-bone forearm procedure. Am J Orthop 29(12):969–972PubMed
52.
go back to reference Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132PubMedCrossRef Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42(172):123–132PubMedCrossRef
53.
go back to reference Mayhall WS, Tiley FT, Paluska DJ (1981) Fracture of silastic radial-head prosthesis. Case report. J Bone Joint Surg Am 63(3):459–460PubMed Mayhall WS, Tiley FT, Paluska DJ (1981) Fracture of silastic radial-head prosthesis. Case report. J Bone Joint Surg Am 63(3):459–460PubMed
55.
go back to reference McGinley JC, Hopgood BC, Gaughan JP, Sadeghipour K, Kozin SH (2003) Forearm and elbow injury: the influence of rotational position. J Bone Joint Surg Am 85-A(12):2403–2409PubMed McGinley JC, Hopgood BC, Gaughan JP, Sadeghipour K, Kozin SH (2003) Forearm and elbow injury: the influence of rotational position. J Bone Joint Surg Am 85-A(12):2403–2409PubMed
56.
go back to reference McGinley JC, Kozin SH (2001) Interosseous membrane anatomy and functional mechanics. Clin Orthop Relat Res 383:108–122PubMedCrossRef McGinley JC, Kozin SH (2001) Interosseous membrane anatomy and functional mechanics. Clin Orthop Relat Res 383:108–122PubMedCrossRef
58.
go back to reference Mikic ZD, Vukadinovic SM (1983) Late results in fractures of the radial head treated by excision. Clin Orthop Relat Res 181:220–228PubMed Mikic ZD, Vukadinovic SM (1983) Late results in fractures of the radial head treated by excision. Clin Orthop Relat Res 181:220–228PubMed
59.
go back to reference Morgan WJ, Breen TF (1994) Complex fractures of the forearm. Hand Clin 10(3):375–390PubMed Morgan WJ, Breen TF (1994) Complex fractures of the forearm. Hand Clin 10(3):375–390PubMed
60.
go back to reference Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83-A(8):1201–1211PubMed Moro JK, Werier J, MacDermid JC, Patterson SD, King GJ (2001) Arthroplasty with a metal radial head for unreconstructible fractures of the radial head. J Bone Joint Surg Am 83-A(8):1201–1211PubMed
61.
go back to reference Morrey BF, Askew L, Chao EY (1981) Silastic prosthetic replacement for the radial head. J Bone Joint Surg Am 63(3):454–458PubMed Morrey BF, Askew L, Chao EY (1981) Silastic prosthetic replacement for the radial head. J Bone Joint Surg Am 63(3):454–458PubMed
62.
go back to reference Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63(6):872–877PubMed Morrey BF, Askew LJ, Chao EY (1981) A biomechanical study of normal functional elbow motion. J Bone Joint Surg Am 63(6):872–877PubMed
63.
go back to reference Murray PM (2005) Diagnosis and treatment of longitudinal instability of the forearm. Tech Hand Up Extrem Surg 9(1):29–34PubMedCrossRef Murray PM (2005) Diagnosis and treatment of longitudinal instability of the forearm. Tech Hand Up Extrem Surg 9(1):29–34PubMedCrossRef
64.
go back to reference Neuber M, Joist A, Joosten U, Rieger H (2000) Consequences and possible treatment of distal radio-ulnar dislocation after Essex-Lopresti lesion. Unfallchirurg 103:1093–1096PubMedCrossRef Neuber M, Joist A, Joosten U, Rieger H (2000) Consequences and possible treatment of distal radio-ulnar dislocation after Essex-Lopresti lesion. Unfallchirurg 103:1093–1096PubMedCrossRef
67.
go back to reference Poitevin LA (2001) Anatomy and biomechanics of the interosseous membrane: its importance in the longitudinal stability of the forearm. Hand Clin 17(1):97–110 viiPubMed Poitevin LA (2001) Anatomy and biomechanics of the interosseous membrane: its importance in the longitudinal stability of the forearm. Hand Clin 17(1):97–110 viiPubMed
68.
go back to reference Rabinowitz RS, Light TR, Havey RM, Gourineni P, Patwardhan AG, Sartori MJ, Vrbos L (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg Am 19(3):385–393. doi:10.1016/0363-5023(94)90050-7PubMedCrossRef Rabinowitz RS, Light TR, Havey RM, Gourineni P, Patwardhan AG, Sartori MJ, Vrbos L (1994) The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg Am 19(3):385–393. doi:10.​1016/​0363-5023(94)90050-7PubMedCrossRef
69.
go back to reference Rodriguez-Martin J, Pretell-Mazzini J, Vidal-Bujanda C (2010) Unusual pattern of Essex-Lopresti injury with negative plain radiographs of the wrist: a case report and literature review. Hand Surg 15(1):41–45PubMedCrossRef Rodriguez-Martin J, Pretell-Mazzini J, Vidal-Bujanda C (2010) Unusual pattern of Essex-Lopresti injury with negative plain radiographs of the wrist: a case report and literature review. Hand Surg 15(1):41–45PubMedCrossRef
70.
go back to reference Ruch DS, Chang DS, Koman LA (1999) Reconstruction of longitudinal stability of the forearm after disruption of interosseous ligament and radial head excision (Essex-Lopresti lesion). J South Orthop Assoc 8(1):47–52PubMed Ruch DS, Chang DS, Koman LA (1999) Reconstruction of longitudinal stability of the forearm after disruption of interosseous ligament and radial head excision (Essex-Lopresti lesion). J South Orthop Assoc 8(1):47–52PubMed
71.
go back to reference Sagerman SD, Short W (1996) Arthroscopic repair of radial-sided triangular fibrocartilage complex tears. Arthroscopy 12(3):339–342PubMedCrossRef Sagerman SD, Short W (1996) Arthroscopic repair of radial-sided triangular fibrocartilage complex tears. Arthroscopy 12(3):339–342PubMedCrossRef
72.
go back to reference Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS (1995) Reconstructive strategies for radioulnar dissociation: a biomechanical study. J Orthop Trauma 9(6):516–522PubMedCrossRef Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS (1995) Reconstructive strategies for radioulnar dissociation: a biomechanical study. J Orthop Trauma 9(6):516–522PubMedCrossRef
74.
go back to reference Shepard MF, Markolf KL, Dunbar AM (2001) Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms. J Bone Joint Surg Am 83-A(1):92–100PubMed Shepard MF, Markolf KL, Dunbar AM (2001) Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms. J Bone Joint Surg Am 83-A(1):92–100PubMed
76.
go back to reference Smith AM, Urbanosky LR, Castle JA, Rushing JT, Ruch DS (2002) Radius pull test: predictor of longitudinal forearm instability. J Bone Joint Surg Am 84-A(11):1970–1976PubMed Smith AM, Urbanosky LR, Castle JA, Rushing JT, Ruch DS (2002) Radius pull test: predictor of longitudinal forearm instability. J Bone Joint Surg Am 84-A(11):1970–1976PubMed
77.
79.
go back to reference Starch DW, Dabezies EJ (2001) Magnetic resonance imaging of the interosseous membrane of the forearm. J Bone Joint Surg Am 83-A(2):235–238PubMed Starch DW, Dabezies EJ (2001) Magnetic resonance imaging of the interosseous membrane of the forearm. J Bone Joint Surg Am 83-A(2):235–238PubMed
80.
go back to reference Stevenson JD, Radesh L, Pickard S, Adrian S, Hay SM (2010) Falsely reassuring magnetic resonance imaging appearance of the forearm interosseous membrane following an Essex-Lopresti injury: does it ever completely heal? Should Elb 2(4):287–290CrossRef Stevenson JD, Radesh L, Pickard S, Adrian S, Hay SM (2010) Falsely reassuring magnetic resonance imaging appearance of the forearm interosseous membrane following an Essex-Lopresti injury: does it ever completely heal? Should Elb 2(4):287–290CrossRef
83.
go back to reference Tomaino MM, Pfaeffle J, Stabile K, Li ZM (2003) Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg Br 28(3):267–270PubMedCrossRef Tomaino MM, Pfaeffle J, Stabile K, Li ZM (2003) Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg Br 28(3):267–270PubMedCrossRef
84.
go back to reference Trousdale RT, Amadio PC, Cooney WP, Morrey BF (1992) Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 74(10):1486–1497PubMed Trousdale RT, Amadio PC, Cooney WP, Morrey BF (1992) Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 74(10):1486–1497PubMed
86.
go back to reference Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN (1994) Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br 76(1):78–81PubMed Vanderwilde RS, Morrey BF, Melberg MW, Vinh TN (1994) Inflammatory arthritis after failure of silicone rubber replacement of the radial head. J Bone Joint Surg Br 76(1):78–81PubMed
87.
88.
go back to reference Worsing RA Jr, Engber WD, Lange TA (1982) Reactive synovitis from particulate silastic. J Bone Joint Surg Am 64(4):581–585PubMed Worsing RA Jr, Engber WD, Lange TA (1982) Reactive synovitis from particulate silastic. J Bone Joint Surg Am 64(4):581–585PubMed
Metadata
Title
The Essex-Lopresti lesion
Authors
K. Wegmann
J. Dargel
K. J. Burkhart
G. P. Brüggemann
L. P. Müller
Publication date
01-11-2012
Publisher
Springer Milan
Published in
Strategies in Trauma and Limb Reconstruction / Issue 3/2012
Print ISSN: 1828-8936
Electronic ISSN: 1828-8928
DOI
https://doi.org/10.1007/s11751-012-0149-0

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