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Essex Lopresti Fracture

- 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.

The Use of Frozen Allograft Radial Head Replacement for Treatment of Established Symptomatic Proximal translation of the Radius: Preliminary Experience in Five Cases.

Primary replacement of the fractured radial head with a metal prosthesis.

The treatment of the acute Essex-Lopresti injury