Chronic Essex-Lopresti injury: a systematic review of current treatment options
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Essex-Lopresti lesion (ELL) is a severe injury. Most of ELL is recognized in chronic phase representing a therapeutic challenge for orthopaedic surgeons. The aim of this systematic review is to highlight and criticize current concepts in the surgical treatment.
Materials and methods
The search was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. A comprehensive research of Pubmed database was made using the following Mesh term: ((Essex-Lopresti injury) OR (Essex Lopresti) OR (distal radio ulnar dissociation) OR (distal radio ulnar dislocation) OR (longitudinal forearm instability)). Quality assessment of each article was performed according to Coleman score by two authors.
Eight full articles were included to the systematic review. Surgical treatment was differentiated in five categories according to the most common procedure reported in clinical series. The mean Coleman Score was 51.13 ± 9.76.
Case series reported in the literature include a limited number of patients with chronic ELL. Currently, salvage procedure devoted to treat a wrong diagnosis and an incorrect treatment is used. Radial head replacement together with ulnar shortening osteotomy and interosseous membrane reconstruction are the most common treatments of choice, but at present, there is not yet a shared scheme of management for patients with chronic ELL.
According to current literature, a case-by-case treatment must always be considered. Further investigations, with higher level of evidence, quality of study design, and number of patients, are needed to better assess clinical results and complication of each technique.
Level of evidence:
KeywordsRadial head fractures TFCC injury Interosseous membrane injury Longitudinal forearm instability
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 4.Edwards GS, Jr., Jupiter JB (1988) Radial head fractures with acute distal radioulnar dislocation. Essex-Lopresti revisited. Clin Orthop Relat Res 234:61–69Google Scholar
- 9.Heijink A, Morrey BF, van Riet RP, O’Driscoll SW, Cooney WP 3rd (2010) Delayed treatment of elbow pain and dysfunction following Essex-Lopresti injury with metallic radial head replacement: a case series. J Shoulder Elbow Surg 19(6):929–936. https://doi.org/10.1016/j.jse.2010.03.007 CrossRefGoogle Scholar
- 12.Szabo RM, Hotchkiss RN, Slater RR Jr (1997) The use of frozen-allograft radial head replacement for treatment of established symptomatic proximal translation of the radius: preliminary experience in five cases. The Journal of Hand Surgery 22(2):269–278. https://doi.org/10.1016/s0363-5023(97)80163-3 CrossRefGoogle Scholar
- 15.Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62(10):e1–e34. https://doi.org/10.1016/j.jclinepi.2009.06.006
- 16.Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10(1):2–11CrossRefGoogle Scholar
- 23.Soubeyrand M, Oberlin C, Dumontier C, Belkheyar Z, Lafont C, Degeorges R (2006) Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure. Surg Radiol Anat 28(3):300–307. https://doi.org/10.1007/s00276-006-0086-z CrossRefGoogle Scholar
- 27.Soubeyrand M, Ciais G, Wassermann V, Kalouche I, Biau D, Dumontier C, Gagey O (2011) The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane. J Bone Joint Surg Brit Vol 93(10):1389–1394. https://doi.org/10.1302/0301-620x.93b10.26590 CrossRefGoogle Scholar
- 30.Ruch DS, Chang DS, Koman LA (1999) Reconstruction of longitudinal stability of the forearm after disruption of interosseous ligament and radial head excision (Essex-Lopresti lesion). J South Orthop Assoc 8(1):47–52Google Scholar