Elbow
Chronic Essex-Lopresti injuries: an alternative treatment method

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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.

Section snippets

Materials and methods

Seven patients (five men and two women) with a mean age of 42.4 years (range, 37 to 58 years) were treated operatively by the senior author (D.G.S.) between 2003 and 2009 for the diagnosis of chronic Essex-Lopresti injury (Table I). The operations were performed on 2 right and 5 left forearms, 4 of which were on the dominant side. Two patients had been injured during motor vehicle accidents, 4 had falls from a height, and 1 had injured her elbow during a sporting event. Three patients had been

Results

The mean follow-up time was 33 months (range, 26 to 52 months). All patients had significant pain relief. The mean preoperative pain score improved from 8.4 points (range, 8 to 10 points) to 3.3 points (range, 2 to 5 points) at the final follow-up (P = .014). Table II shows the preoperative and postoperative data for each case.

Range of motion significantly improved postoperatively. The elbow arc of motion increased on average from 79° preoperatively to 121° postoperatively (P = .028). The mean

Discussion

Management of the chronic Essex-Lopresti lesion continues to be a challenging therapeutic entity. Several methods have been reported in the literature, but none has met general acceptance. The main goal when treating such injuries is to re-establish the longitudinal relationship between the radius and ulna. Restoration of the proximal radioulnar joint (PRUJ) and DRUJ is the key to regaining painless elbow and wrist function.

The pathognomonic lesion in Essex-Lopresti injury is the rupture of the

Conclusion

Forearm instability is an extremely complex problem that must be recognized and addressed early for a successful outcome.30 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. It is a dependable procedure with predictable and satisfactory outcomes and a low complication rate.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (30)

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Allegheny-Singer Research–West Penn Allegheny Health System Institutional Review Board (Pittsburgh, PA, USA) approval was obtained for this study (No. RC-5048).

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