- Discussion:
- radial head frx plus dislocation of distal RU joint (& interosseous membrane disruption);
- mechanism: fall from height;
- in this type of frx, radius will also migrate proximally if radial head is excised;
- if injury is not found when it is acute, pt may develop severe wrist pain from radial migration and subluxation, of upto 5-6 mm;
- there may be loss of forearm pronation, supination, and extension;
- late reconstruction( > 4 weeks) of radial instability yields poor results;
- Exam:
- distal radio-ulnar joint tenderness is most sensitive test to diagnose injury;
- Radiographs:
- lateral view of pronated wrist may show ulna to be dorsally subluxated;
- Management:
- RU joint:
- full supination of the forearm usually results in reduction of RU joint dislocation;
- in order to maintain inadequate radial length & RU joint reduction, consider pinning of RU joint for 6 weeks to allow for
anatomic healing of interosseous membrane;
- radial head:
- ORIF is indicated unless comminution precludes adequate fixation;
- type III radial head fracture;
- Kocher approach
- radial head implants:
- indicated when ORIF is not possible;
- avoid using silicone prosthesis for the Essex Lopresti injury since this material is inadequate to withstand the compression
forces across the radiocapitellar joint;
- besides migration of the radius, implant fracture, and synovitis are common complications;
- avoid radial head excision:
- excision of radial head will result in proximal migration of radius, along w/ severe wrist pain (ulnacarpal impingement) as
well as elbow pain
- References:
Outcome of Early and Late Diagnosed Essex-Lopresti Injury
Late Reconstruction of the Interosseous Membrane with Bone-Patellar Tendon-Bone Graft for Chronic Essex-Lopresti Injuries: Outcomes with a Mean Follow-up of Over 10 Years
Radial head fractures and their effect on the distal radioulnar joint. A rationale for treatment.
Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited.
Fractures of the radial head with distal radio-ulnar dislocation; report of two cases.
Primary replacement of the fractured radial head with a metal prosthesis.