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Diagnostik und Behandlung der Essex-Lopresti-Verletzung

Literaturanalyse und 4 Fallbeispiele

Diagnosis and treatment of the Essex-Lopresti lesion

Literature review and four case reports

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Zusammenfassung

Einleitung

Die seltene, nach Essex-Lopresti benannte, Unterarmverletzung ist durch eine Radiusköpfchenfraktur in Verbindung mit einer Verletzung der interossären Membran (IOM) sowie des distalen Radioulnargelenks charakterisiert. Zugrunde liegt meist ein Hochrasanztrauma. Sie wird initial häufig übersehen und zeigt klinisch/funktionell in vielen Fällen schlechte Ergebnisse.

Patienten und Methoden

Anhand von 4 Fallbeispielen werden Unfallmechanismus, Diagnostik und Therapieoptionen aufgezeigt. Besonderes Augenmerk galt der Sonographie, die sich als meist verfügbares Diagnostikum eignet, Rupturen der IOM aufzuzeigen.

Ergebnisse

Die Nachuntersuchung nach durchschnittlich 35 Monaten erfolgte anhand des Score von Morrey und dem modifizierten Score von Green u. O’Brien, welche sowohl subjektive als auch objektive Parameter berücksichtigen. Auch in 3 unserer Fälle war die Diagnose erst verzögert gestellt worden. Die Ergebnisse entsprechend der Scores waren im Schnitt befriedigend.

Schlussfolgerung

Wichtig ist die frühzeitige Diagnose. Hierbei ist ergänzend zur Röntgendiagnostik die Sonographie hilfreich. Basierend auf der Einteilung nach Edwards und Jupiter kann ein typenabhängiges, wenn auch nicht evidenzbasiertes, Behandlungskonzept abgeleitet werden.

Abstract

Background

A fracture of the radial head in combination with a rupture of the interosseous membrane and lesion of the distal radioulnar joint known as Essex-Lopresti lesion is a rare injury. Usually it is caused by a high-energy trauma. Initially unrecognized distal radioulnar dislocations often show poor results.

Material and method

Four case reports are presented to discuss the trauma mechanism together with diagnostic and treatment options. Especially the accuracy of ultrasound to diagnose an interosseous membrane disruption was evaluated.

Results

After an average of 35 months all patients were examined using the Morrey score and the modified score of Green and O’Brien. Initially the extent of the injury was not diagnosed in three cases. According to the score values the average results have been fair.

Conclusions

An early diagnosis is the key for the correct treatment of an Essex-Lopresti lesion based on the classification of Edwards and Jupiter. In addition to the clinical and radiological assessment ultrasound should be used to diminish the rate of unrecognized interosseous membrane disruptions.

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Authors and Affiliations

  1. Department für Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs-Universität, Hugstetterstraße 55, 79106, Freiburg i.B.

    A. Doser,  P. C. Strohm & N. P. Südkamp

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Klinikum Kempten Oberallgäu

    M. Markmiller

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  1. A. Doser
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  2. M. Markmiller
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  4. N. P. Südkamp
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Correspondence to P. C. Strohm.

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Doser, A., Markmiller, M., Strohm, P.C. et al. Diagnostik und Behandlung der Essex-Lopresti-Verletzung. Unfallchirurg 109, 593–599 (2006). https://doi.org/10.1007/s00113-006-1113-6

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  • DOI: https://doi.org/10.1007/s00113-006-1113-6

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