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Review
. 2018 Aug 29;19(1):312.
doi: 10.1186/s12891-018-2232-2.

Diagnosis and Treatment of Acute Essex-Lopresti Injury: Focus on Terminology and Review of Literature

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Free PMC article
Review

Diagnosis and Treatment of Acute Essex-Lopresti Injury: Focus on Terminology and Review of Literature

Maurizio Fontana et al. BMC Musculoskelet Disord. .
Free PMC article

Abstract

Background: Acute Essex-Lopresti injury is a rare and disabling condition of longitudinal instability of the forearm. When early diagnosed, patients report better outcomes with higher functional recovery. Aim of this study is to focus on the different lesion patterns causing forearm instability, reviewing literature and the cases treated by the Authors and to propose a new terminology for their identification.

Methods: Five patients affected by acute Essex-Lopresti injury have been enrolled for this study. ELI was caused in two patients by bike fall, two cases by road traffic accident and one patient by fall while walking. A literature search was performed using Ovid Medline, Ovid Embase, Scopus and Cochrane Library and the Medical Subject Headings vocabulary. The search was limited to English language literature. 42 articles were evaluated, and finally four papers were considered for the review.

Results: All patients were operated in acute setting with radial head replacement and different combinations of interosseous membrane reconstruction and distal radio-ulnar joint stabilization. Patients were followed for a mean of 15 months: a consistent improvement of clinical results were observed, reporting a mean MEPS of 92 and a mean MMWS of 90.8. One case complained persistent wrist pain associated to DRUJ discrepancy of 3 mm and underwent ulnar shortening osteotomy nine months after surgery, with good results.

Discussion: The clinical studies present in literature reported similar results, highlighting as patients properly diagnosed and treated in acute setting report better results than patients operated after four weeks. In this study, the definitions of "Acute Engaged" and "Undetected at Imminent Evolution" Essex-Lopresti injury are proposed, in order to underline the necessity to carefully investigate the anatomical and radiological features in order to perform an early and proper surgical treatment.

Conclusions: Following the observations, the definitions of "Acute Engaged" and "Undetected at Imminent Evolution" injuries are proposed to distinguish between evident cases and more insidious settings, with necessity of carefully investigate the anatomical and radiological features in order to address patients to an early and proper surgical treatment.

Keywords: Acute Essex-Lopresti injury; Elbow; Forearm instability; Wrist.

Conflict of interest statement

Ethics approval and consent to participate

The work presented in this paper obtained the IRB approval of our Institution (Comitato etico dell’ IRCCS Istituto Ortopedico Rizzoli, prot.gen. 0011803), and all patients enrolled signed the informed consent.

Consent for publication

Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/ relative of the patient. A copy of the consent form is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Clinical case 4, Acute Engaged ELI, pre-operative: elbow. Pre-operative left elbow X-rays (a, b, c) and 3D reconstruction CT scan (d) images showing a Mason 3 radial head fracture
Fig. 2
Fig. 2
Clinical case 4, pre-operative: wrist. Pre-operative X-rays of the same patient. The left wrist (a, b) highlighted a DRUJ lesion, more evident if compared to the right unaffected wrist images (c, d)
Fig. 3
Fig. 3
Clinical case 2: Acute Undetected at Imminent Evolution ELI pattern. Pre-operative X-ray of case n. 2: it is evident the radial head fracture without evident signs of high energy trauma (a, b). The DRUJ seemed aligned ad regular X-Ray (c). Performing the stress test under C-arm view the forearm longitudinal instability was detected (d, e). The treatment consisted in radial head prosthesis positioning (g), IOM plasty and collateral ligaments reconstruction (f)
Fig. 4
Fig. 4
C-Fingers comparative test. Clinical image of the C-Fingers comparative test: the arm lies on a table, with elbow flexed at 90° and forearm vertical to the floor plane. With the thumb opposite to other fingers (forming the shape of a “C” letter) the surgeon squeezes the forearm space and pushes alternatively in dorsal and palmar direction to feel the muscular-IOM resistance in pronation and supination; the test must be comparative and is generally hindered by muscular hypertrophy and edema
Fig. 5
Fig. 5
Surgical images of the procedure, clinical case 3. The radial head prosthesis was firstly positioned (a), followed by TFCC reconstruction and DRUJ pinning (b). At the level of the maximum radial bow, passing between flexor and extensor muscles, the radial origin of the pronator teres was recognized and isolated (c). At intermediate forearm rotation two 1.5 mmm drill were performed (d)
Fig. 6
Fig. 6
Surgical images of the procedure clinical case 3. With the help of a smooth tool the path for the stabilizer device was performed, dorsally crossing the forearm bones under the muscular extensor compartment (a). The stabilizer device was then put in position with the help of a knee ligament passer (b) and finally tensioned (c)
Fig. 7
Fig. 7
Post operative X-rays, clinical case 3. Post operative X-rays show the reduced and stabilized DRUJ (a, b) and the radial head prosthesis (c). It is possible to see the radial and ulnar tunnels of the two bundles of the newly reconstructed IOM (a)
Fig. 8
Fig. 8
1 year X-rays, clinical case 3. Follow up X-rays at 1 year of follow up, showing the radial head prosthesis in situ and the whole forearm (a). The lateral view shows no dorsal dislocation of the distal ulna (b). At the DRUJ a slight recurrence of the ulnar plus is evident (c), even if non symptomatic. Nevertheless the improvement pre-operative wrist x-ray (d) is evident. e Image shows the opposite side normal wrist
Fig. 9
Fig. 9
Clinical follow up, clinical case 3. Follow up clinical aspect at 1 year of follow up, showing a good movement of the elbow (a-d) and the wrist (e, f)

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