Chronic Essex-Lopresti injuries: an alternative treatment method

J Shoulder Elbow Surg. 2014 Jun;23(6):861-6. doi: 10.1016/j.jse.2014.01.043. Epub 2014 Apr 22.


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.

Conclusion: 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.

Level of evidence: Level IV, case series, treatment study.

Keywords: Elbow; Essex-Lopresti; forearm; instability; osteotomy; radial head replacement.

MeSH terms

  • Adult
  • Chronic Disease
  • Elbow Injuries
  • Elbow Joint / surgery
  • Female
  • Forearm Injuries / surgery*
  • Fractures, Comminuted / diagnostic imaging
  • Fractures, Comminuted / surgery
  • Humans
  • Male
  • Middle Aged
  • Osteotomy
  • Radiography
  • Radius Fractures / diagnostic imaging
  • Radius Fractures / surgery*
  • Range of Motion, Articular
  • Treatment Outcome
  • Ulna / injuries
  • Ulna / surgery*
  • Wrist Injuries / surgery*