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Kanaya F, Kinjo M, Nakasone M, Okubo H, Miyagi W, Nishida K. Preoperative radius head dislocation affects forearm rotation after mobilization of congenital radioulnar synostosis. J Orthop Sci 2023; 28:1285-1290. [PMID: 36372679 DOI: 10.1016/j.jos.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 09/20/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The present study was carried out to answer three questions: 1) How much forearm rotation can be expected after mobilization of congenital radioulnar synostosis (CRUS)? 2) Does preoperative radius head dislocation affect forearm rotation after mobilization? 3) What factors other than radius head dislocation affect postoperative forearm rotation? METHODS We performed mobilization of CRUS with a free vascularized fascio-fat graft and a radius osteotomy (Kanaya's procedure) on 26 forearms of 25 patients. The age at the surgery ranged from 5.3 to 13.4 years. The follow-up duration ranged 24-111 months. We classified CRUS into 3 groups according to the dislocation of the radius head: posterior dislocation (N = 13), anterior dislocation (N = 9) and no dislocation (N = 4). Since major complaints of patients and parents were poor forearm rotation and lack of supination, they were evaluated separately. RESULTS Mean preoperative forearm ankylosis angle was 34.8° (range; neutral to 90° pronation). Preoperative pronation ankylosis angle was higher in the posterior dislocation group (mean 55.3°) than the anterior dislocation (mean 11.6°) and no dislocation groups (mean 5.0°). There was no re-ankylosis after mobilization and the mean postoperative active range of motion (ROM) was 86.5°. The mean active ROM was 75.7° in the posterior dislocation group, 96.1° in anterior dislocation group and 100.0° in no dislocation group. The mean active supination was 6.9, 33.9 and 47.5° respectively. The posterior dislocation group showed less ROM and less supination than other groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM (ρ = - 0.59) and postoperative supination (ρ = - 0.73). CONCLUSION The mean postoperative active ROM of this mobilization was 86.5°. Posterior dislocation group showed higher pronation ankylosis angle preoperatively, and less postoperative ROM and less supination than anterior and no dislocation groups. Preoperative pronation ankylosis angle showed negative correlation with postoperative ROM and supination.
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Affiliation(s)
- Fuminori Kanaya
- Department of Orthopedic Surgery, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan; Tominaga-Kusano Hospital, Sanjo, Niigata, Japan.
| | - Masaki Kinjo
- Department of Orthopedic Surgery, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan
| | - Motoko Nakasone
- Department of Orthopedic Surgery, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan
| | - Hirotaka Okubo
- Department of Orthopedic Surgery, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan
| | - Wakako Miyagi
- Rehabilitation Unit, Ryukyu University Hospital. Okinawa, Japan
| | - Kotaro Nishida
- Department of Orthopedic Surgery, University of the Ryukyus, Graduate School of Medicine, Okinawa, Japan
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Muacevic A, Adler JR, Charalampus H, Athanasiou V, Panagopoulos A, Kokkalis Z. Elbow Dislocation With Associated Essex-Lopresti Injury: A Case Treated Conservatively. Cureus 2022; 14:e32099. [PMID: 36601210 PMCID: PMC9805318 DOI: 10.7759/cureus.32099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/03/2022] Open
Abstract
A 23-year-old woman suffered a posterior elbow dislocation, distal radius intraarticular fracture, distal radioulnar joint subluxation, and coronoid process fracture, suggesting an Essex-Lopresti injury variant. Closed reduction for the elbow dislocation was performed, and the limb was immobilized at a 90-degree angle with the forearm in a neutral position with a long posterior splint. Three months later complete fracture healing was noted radiologically. One year post-injury full range of motion regarding flexion, pronation, and supination was achieved with only 10 degrees of extension deficit remaining, suggesting a case of Essex-Lopresti injury managed conservatively with excellent results.
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Kaul R, Sood C, Akhoon N. Concomitant Fracture Radial Head and Shaft With Dislocation of the Distal Radioulnar Joint: A Rare Variant of the Essex-Lopresti Lesion. J Am Acad Orthop Surg Glob Res Rev 2022; 6:e22.00042. [PMID: 35944114 PMCID: PMC10567035 DOI: 10.5435/jaaosglobal-d-22-00042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/25/2022] [Indexed: 06/15/2023]
Abstract
The Essex-Lopresti lesion is a challenging injury both for diagnosis and management. These often tend to be missed, resulting in incapacitating pain and joint stiffness despite treatment. In rare circumstances, they may occur in association with other injuries of the forearm or elbow. We describe an atypical Essex-Lopresti variant comprising a radial head and shaft fracture with an associated distal radioulnar joint dislocation in a 36-year-old man.
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Affiliation(s)
- Rajiv Kaul
- From the Military Hospital Dehradun, Dehradun, India (Dr. Kaul and Dr. Akhoon), and the Department of Orthopaedics, Armed Forces Medical College, Pune, India (Dr. Sood)
| | - Chetan Sood
- From the Military Hospital Dehradun, Dehradun, India (Dr. Kaul and Dr. Akhoon), and the Department of Orthopaedics, Armed Forces Medical College, Pune, India (Dr. Sood)
| | - Neha Akhoon
- From the Military Hospital Dehradun, Dehradun, India (Dr. Kaul and Dr. Akhoon), and the Department of Orthopaedics, Armed Forces Medical College, Pune, India (Dr. Sood)
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An Unusual Terrible Triad Variant Associated with an Essex-Lopresti Injury. Case Rep Orthop 2021; 2021:8522303. [PMID: 34580615 PMCID: PMC8464426 DOI: 10.1155/2021/8522303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/22/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Essex-Lopresti injuries and terrible triad injuries of the elbow are rare injuries that typically result from high-energy trauma such as falling from a height or a motor vehicle collision. However, the combination of an Essex-Lopresti injury and terrible triad injury is unique and poses a significant challenge for treatment as these injuries are independently associated with poor functional outcomes if they are not acutely diagnosed. We describe a case of a 19-year-old who presented with an unusual variant of a terrible triad injury associated with an Essex-Lopresti injury. The patient had a distal radioulnar joint (DRUJ) and elbow dislocation, a radial head and coronoid process fracture, and a distal radius fracture. Almost a reverse Essex-Lopresti, this injury was successfully managed with open reduction and repair of the distal radius, radial head, and damaged ligaments in the elbow, along with an internal joint stabilizer (IJS).
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Bagley JJ, Della Rocca GJ, Smith MJ, Kim HM. Optimal Prosthesis Sizing for Radial Head Arthroplasty: A Review of Current Evidence and Guidelines. JBJS Rev 2021; 9:01874474-202104000-00012. [PMID: 33886524 DOI: 10.2106/jbjs.rvw.20.00178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Radial head arthroplasty is a viable surgical option when a radial head fracture cannot be reconstructed. Radial head arthroplasty provides a load-bearing articular structure against the capitellum in unstable fractured elbows. » Studies have emphasized the importance of choosing the correct implant size to replicate the native radial head anatomy, citing various consequences of improperly sized radial head prostheses. Overstuffing of the radiocapitellar joint, or lengthening of the radius, has been extensively studied because of its detrimental effects on elbow biomechanics, but other types of improper sizing also have negative consequences. » In the setting of severe fracture-dislocation or revision surgery, anatomic landmarks that are useful for prosthesis sizing often are missing. Various methods have been described to provide guidance for the accurate sizing of a prosthetic radial head; a retrieved radial head, the proximal edge of the lesser sigmoid notch, the radiocapitellar synovial fold, and the ulnohumeral joint space all represent useful references. » Intraoperative radiographic examination is an important step while assessing implant size, including the height of the prosthetic radial head. » Since no single method is perfect on its own, the surgeon should combine as many reference measures as possible, both before and during the procedure, for accurate prosthesis sizing in order to achieve successful outcomes.
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Affiliation(s)
- Joshua J Bagley
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Gregory J Della Rocca
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - Matthew J Smith
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
| | - H Mike Kim
- Department of Orthopaedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri
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Logli AL, Pulos N. Problems of Eponymous Proportions: The History Behind Recognizing Forearm Instability Issues. Hand Clin 2020; 36:397-406. [PMID: 33040952 DOI: 10.1016/j.hcl.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Three predictable patterns of forearm fracture-dislocation-Essex-Lopresti, Monteggia, and Galeazzi-can occur and are eponymously labeled for the investigators who appreciated their unique characteristics and offered a framework by which to understand them. Recognition of these injuries and subsequent investigation and increased understanding of these lesions have resulted in improved understanding about forearm anatomy and stability. Management of the component of instability differs based on the type of fracture-dislocation, the timing of intervention, and surgeon preference. Despite advances in understanding and treating these injuries, nuances of these lesions may remain challenging to modern-day surgeons.
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Affiliation(s)
- Anthony L Logli
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. https://twitter.com/AnthonyLogliMD
| | - Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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Verma D, Kumar S, Dhammi IK, Kumar R, Kapoor R. Isolated Radial Shaft Fracture with Unreducable Posterior Dislocation of the Radial Head in Adult: A Case Report. J Orthop Case Rep 2020; 10:61-64. [PMID: 33312982 PMCID: PMC7706448 DOI: 10.13107/jocr.2020.v10.i05.1840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Isolated fracture of the radial diaphysis with dislocation of the radial head is a rare injury, which requires careful evaluation. Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. CASE REPORT A 35-year-old male presented to our emergency department with a history of fall in ditch under influence of alcohol with swelling of her right elbow and deformity of right upper limb. Roentgenograms showed oblique fracture of the radial shaft and dislocation of radial head posteriorly. He underwent open reduction and internal fixation of fracture with limited contact dynamic compression plate and reduction of radial head and fixing with radiocapitellar wire. After 4 months, the fracture healed fully and he had complete full range of elbow movements. CONCLUSION Ipsilateral radial head dislocation and radial shaft fracture are extremely rare injury in a child. A good outcome can be achieved by applying principles of the management of proximal forearm fracture-dislocation. Ipsilateral radial head dislocation and radial shaft fracture is extremely rare injury in a child. A good outcome can be achieved by applying principles of management of proximal forearm fracture-dislocation.
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Affiliation(s)
- Deepankar Verma
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Saurabh Kumar
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India,Address of Correspondence: Dr. Saurabh Kumar, Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India. E-mail:
| | - Ish Kumar Dhammi
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rajnand Kumar
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Rajat Kapoor
- Department of Orthopaedics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India
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Mazhar FN, Ebrahimi H, Jafari D, Mirzaei A. Radial head resection versus prosthetic arthroplasty in terrible triad injury: a retrospective comparative cohort study. Bone Joint J 2018; 100-B:1499-1505. [DOI: 10.1302/0301-620x.100b11.bjj-2018-0293.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aims The crucial role of the radial head in the stability of the elbow in terrible triad injury is acknowledged. This retrospective study aims to compare the results of resection of a severely comminuted radial head with or without prosthetic arthroplasty as part of the reconstruction for this injury. Patients and Methods The outcome of radial head resection was compared with prosthetic arthroplasty in 29 and 15 patients with terrible triad injuries, respectively. There were ten female patients (34.5%) in the resection group and six female patients (40%) in the prosthesis group. The mean age was 40.7 years (sd 13.6) in the resection group and 36 years (sd 9.4) in the prosthesis group. The mean follow-up of the patients was 24.4 months (sd 12) in the resection group and 45.8 months (sd 6.8) in the prosthesis group. Outcome measures included visual analogue scale (VAS) for pain, Mayo Elbow Performance Score (MEPS), Disabilities of Arm, Shoulder and Hand (DASH) Score, and range of movement. Postoperative radiological complications were also recorded. Results The mean ranges of extension, flexion, supination, and pronation were not significantly different between the two study groups (p = 0.75, p = 0.65, p = 0.82, and p = 0.68, respectively). The mean VAS score, DASH score, and MEPS of the two groups were also not statistically significantly different (p = 0.93, p = 0.19, and p = 0.32, respectively). At the final visit, the elbow was stable in all patients. No patient was found to have developed an Essex–Lopresti injury. Osteoarthritis grade I and II was observed in five and three patients of the resection group, respectively, and four and one patients of the arthroplasty group, respectively. Conclusion The outcome of patients undergoing treatment for terrible triad injuries is similar whether the patient’s radial head was excised or replaced. Cite this article: Bone Joint J 2018;100-B:1499–505.
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Affiliation(s)
- F. Najd Mazhar
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - H. Ebrahimi
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - D. Jafari
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - A. Mirzaei
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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Fontana M, Cavallo M, Bettelli G, Rotini R. Diagnosis and treatment of acute Essex-Lopresti injury: focus on terminology and review of literature. BMC Musculoskelet Disord 2018; 19:312. [PMID: 30157823 PMCID: PMC6116505 DOI: 10.1186/s12891-018-2232-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
Background Acute Essex-Lopresti injury is a rare and disabling condition of longitudinal instability of the forearm. When early diagnosed, patients report better outcomes with higher functional recovery. Aim of this study is to focus on the different lesion patterns causing forearm instability, reviewing literature and the cases treated by the Authors and to propose a new terminology for their identification. Methods Five patients affected by acute Essex-Lopresti injury have been enrolled for this study. ELI was caused in two patients by bike fall, two cases by road traffic accident and one patient by fall while walking. A literature search was performed using Ovid Medline, Ovid Embase, Scopus and Cochrane Library and the Medical Subject Headings vocabulary. The search was limited to English language literature. 42 articles were evaluated, and finally four papers were considered for the review. Results All patients were operated in acute setting with radial head replacement and different combinations of interosseous membrane reconstruction and distal radio-ulnar joint stabilization. Patients were followed for a mean of 15 months: a consistent improvement of clinical results were observed, reporting a mean MEPS of 92 and a mean MMWS of 90.8. One case complained persistent wrist pain associated to DRUJ discrepancy of 3 mm and underwent ulnar shortening osteotomy nine months after surgery, with good results. Discussion The clinical studies present in literature reported similar results, highlighting as patients properly diagnosed and treated in acute setting report better results than patients operated after four weeks. In this study, the definitions of “Acute Engaged” and “Undetected at Imminent Evolution” Essex-Lopresti injury are proposed, in order to underline the necessity to carefully investigate the anatomical and radiological features in order to perform an early and proper surgical treatment. Conclusions Following the observations, the definitions of “Acute Engaged” and “Undetected at Imminent Evolution” injuries are proposed to distinguish between evident cases and more insidious settings, with necessity of carefully investigate the anatomical and radiological features in order to address patients to an early and proper surgical treatment.
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Affiliation(s)
- Maurizio Fontana
- Orthopaedic Department, Infermi Hospital, Viale Stradone 9, 48018, Faenza, Italy
| | - Marco Cavallo
- Shoulder and Elbow Unit, IRCCS - Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy.
| | - Graziano Bettelli
- Shoulder and Elbow Unit, IRCCS - Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy
| | - Roberto Rotini
- Shoulder and Elbow Unit, IRCCS - Istituto Ortopedico Rizzoli, Via G.C. Pupilli 1, Bologna, Italy
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Abstract
Essex-Lopresti Lesions are rare injuries that are often missed in the acute setting. Delayed intervention may lead to chronic wrist and elbow pain and overall poor outcomes. The literature currently supports treatments that involve shortening of the ulna to reduce the relative degree of ulnar impaction, followed by attempted reduction of the distal radioulnar joint. Although such techniques may help to temporarily reduce wrist pain secondary to ulnar impaction, they do not address the proximal migration of the radius and ipsilateral radial head dislocation at the elbow. Subsequent procedures are often needed to replace or resect the radial head. We present a novel approach to chronic Essex-Lopresti lesions resulting in anatomic restoration of forearm length with return of elbow and wrist flexion/extension as well as improved forearm pronation/supination.
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Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Pereira Consoni DA, Ruggiero GM. Reconstrução da membrana interóssea do antebraço no tratamento da instabilidade da articulação da radioulnar distal. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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12
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Aita MA, Mallozi RC, Ozaki W, Ikeuti DH, Consoni DAP, Ruggiero GM. Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint. Rev Bras Ortop 2018; 53:184-191. [PMID: 29911085 PMCID: PMC6001153 DOI: 10.1016/j.rboe.2018.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/02/2016] [Indexed: 11/17/2022] Open
Abstract
Objectives To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ). Methods From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described. Results The follow-up time was 20 months (6-36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1-6). DASH was 5.63/100 (1-18). The time to return to work was 7.37 months (3-12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well. Conclusion The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.
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Affiliation(s)
| | | | - Willian Ozaki
- Faculdade de Medicina do ABC, Santo André, SP, Brazil
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13
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Schnetzke M, Porschke F, Hoppe K, Studier-Fischer S, Gruetzner PA, Guehring T. Outcome of Early and Late Diagnosed Essex-Lopresti Injury. J Bone Joint Surg Am 2017. [PMID: 28632594 DOI: 10.2106/jbjs.16.01203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to investigate the outcomes in a large series of Essex-Lopresti injuries (ELIs) and to compare patients with early and late diagnoses. METHODS Thirty-one patients with an ELI (average age and standard deviation [SD], 46 ± 10 years) who were followed for a minimum of 2 years were included in the study. Patients were grouped according to whether the ELI had been diagnosed early (on the day of the injury) or late (>4 weeks after the radial head injury). Acute treatment of early-diagnosed ELI included temporary stabilization of the distal radioulnar joint (DRUJ) by Kirschner wires with the forearm in supination for 6 weeks. Clinical outcomes were assessed on the basis of the range of motion, Mayo Elbow Performance Score (MEPS), Mayo Wrist Score (MWS), visual analog scale (VAS) score for wrist and elbow pain, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS The ELI was diagnosed on the day of the injury in 16 patients (52%; the early group) and late (at a mean of 7 ± 7 months; range, 1 to 24 months) in 15 (48%; the late group). After a mean duration of follow-up of 5.3 ± 3.0 years (range, 2.0 to 13.1 years), patients with an early diagnosed ELI had significantly better clinical outcomes, compared with those with a late diagnosis, with regard to the MEPS (91.3 ± 8.7 versus 74.7 ± 15.3, p = 0.003), MWS (81.3 ± 16.5 versus 66.3 ± 17.6, p = 0.019), DASH score (12.5 ± 8.7 versus 45.3 ± 23.5, p = 0.001), VAS elbow pain score (0.7 ± 1.1 versus 3.3 ± 2.1, p = 0.001), and VAS wrist pain score (0.9 ± 1.2 versus 3.9 ± 1.7, p < 0.001). The ranges of motion of the elbow and wrist did not differ significantly between the early and late groups (p > 0.05). A significantly lower percentage of patients had complications or subsequent surgical procedures in the early than in the late group (38% [6 of 16] versus 93% [14 of 15], p < 0.001). CONCLUSIONS Early diagnosis of an ELI with temporary stabilization of the DRUJ leads to satisfactory clinical mid-term results, whereas late diagnosis of an ELI is associated with a deteriorated outcome. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Marc Schnetzke
- 1Department of Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, Ludwigshafen on the Rhine, Germany
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14
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Wegmann K, Zhang W, Strauss V, Ries C, Müller LP, Burkhart KJ. Is the distal radioulnar variance useful for identification of radial head prosthesis overlengthening? A cadaver study. Eur J Med Res 2016; 21:12. [PMID: 27000659 PMCID: PMC4802733 DOI: 10.1186/s40001-016-0196-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overlengthening by radial head prosthetic replacement leads to insufficient functionality and increased capitellar wear. It has been shown that in monopolar prostheses, the radial overlengthening by an overstuffed prosthesis leads to significant differences in the distal radioulnar variance at the wrist. This study evaluated ipsilateral ulnar variance as a predictor for overlengthening after implantation of a multipolar prosthesis. METHODS The radial heads of seven fresh frozen upper extremities were resected and a multipolar radial head prosthesis was implanted. Thereafter, the native radioulnar variance at the wrist was documented via fluoroscopy. The alignment of the distal radioulnar joint in neutral, pronated and supinated rotational positions of the forearm was recorded fluoroscopically, and digital image analysis was performed regarding radioulnar shifting. RESULTS Statistical analysis of the difference between native height and the manipulated states did not show consistent significant differences with stepwise overlengthening of +1.5, +3, +4.5 and +6 mm and with respect to rotational position of the forearm (p > 0.05). Interclass correlation coefficients showed excellent interobserver reliability (ICC 96%), as did tests for intraobserver reliability (ICC 98-99%). CONCLUSIONS No consistent influence of overlengthening on the alignment of the radius and ulna at the distal radioulnar joint was found after sequential overlengthening with a multipolar prosthesis. Maybe the ligamentous structures of the forearm prevent significant longitudinal dislocation of the radius, as the multipolar prosthesis gives way by at the radiocapitellar joint. According to the data of the present study, the ipsilateral wrist is not useful in diagnosing overlengthening of the radial column in multipolar prosthetic replacement of the radial head-in contrast to the reported results with monopolar prostheses.
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Affiliation(s)
- Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Josef-Stelzmann-Str.9, 50924, Cologne, Germany. .,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Josef-Stelzmann-Str.9, 50924, Cologne, Germany.
| | - Wei Zhang
- Center for Orthopedic and Trauma Surgery, University Medical Center, Josef-Stelzmann-Str.9, 50924, Cologne, Germany
| | - Volker Strauss
- Center for Orthopedic and Trauma Surgery, University Medical Center, Josef-Stelzmann-Str.9, 50924, Cologne, Germany
| | - Christian Ries
- Center for Orthopedic and Trauma Surgery, University Medical Center, Josef-Stelzmann-Str.9, 50924, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Josef-Stelzmann-Str.9, 50924, Cologne, Germany
| | - Lars P Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Josef-Stelzmann-Str.9, 50924, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Josef-Stelzmann-Str.9, 50924, Cologne, Germany
| | - Klaus J Burkhart
- Arcus Klinik , Raststatter Straße 17-19, 75179, Pforzheim, Germany
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Intraoperative Technique for Evaluation of the Interosseous Ligament of the Forearm. J Hand Surg Am 2015; 40:2372-6.e1. [PMID: 26547797 DOI: 10.1016/j.jhsa.2015.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To introduce a technique for the diagnosis of interosseous ligament (IOL) disruption based on lateral displacement of the radius after radial head resection and to determine the cutoff value of the lateral displacement for the diagnosis of disruption, the best elbow position for testing, and the diagnostic performance of the technique in different positions. METHODS We used 10 fresh-frozen cadavers. After resection of the radial head, a Steinman pin was placed into the radius medullary canal and used to mark the pin location on the capitellum. We applied 1 kg force to pull the proximal radius laterally and measured the displacement in full supination, neutral, and full pronation of the forearm with the elbow in extension and then in 90° flexion. All measurements were performed once with the IOL intact and again with it cut. To assess diagnostic efficacy, receiver operating characteristics curves were constructed. To determine the quality of the technique, we measured the area under the receiver operating characteristics curve for each position. We also determined the cutoff value to obtain the highest sensitivity and specificity. RESULTS The area under the curve of the test in extension-supination and flexion-supination showed that these positions were excellent for the diagnosis of IOL disruption. The cutoff value of 5.5 mm lateral displacement in extension-supination had 100% sensitivity and 90% specificity. In flexion-supination, the cutoff value of 9 mm had 100% sensitivity and 90% specificity for the diagnosis of IOL disruption. CONCLUSIONS This maneuver was reliable and accurate in cadavers with complete IOL disruption. It is likely that in an intraoperative setting, these results will be reproducible. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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Abstract
Radial head fractures are the most common fractures around the elbow. Because they are often accompanied by ligamentous injuries, we recommend considering them to be osteoligamentous injuries rather than simple fractures, even in undisplaced or minimally displaced fractures. Surgeons should always suspect and actively exclude concomitant ligament tears. The incidence of these associated injuries increases with greater severity of the radial head fracture. However, the standard Mason classification system does not adequately address this problem, and all attempts to establish a new classification system that provides concise treatment algorithms have failed. This article discusses the current treatment options and the current controversies in nonsurgical therapy, open reduction and internal fixation (ORIF) and radial head replacement.
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Affiliation(s)
- Klaus Josef Burkhart
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany.
| | - Kilian Wegmann
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Lars P Müller
- Department for Trauma, Hand and Elbow Surgery, University of Cologne, Kerpener Straße 62, 50937 Köln, Germany
| | - Frank E Gohlke
- Department for Shoulder Surgery, Rhön-Clinic, Bad Neustadt, Salzburger Leite 1, 97616 Bad Neustadt/Saale, Germany
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17
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Wong PKW, Hanna TN, Shuaib W, Sanders SM, Khosa F. What's in a name? Upper extremity fracture eponyms (Part 1). Int J Emerg Med 2015. [PMID: 26223984 PMCID: PMC4519440 DOI: 10.1186/s12245-015-0075-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Eponymous extremity fractures are commonly encountered in the emergency setting. Correct eponym usage allows rapid, succinct communication of complex injuries. We will review both common and less frequently encountered extremity fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We focus on plain radiographic findings, with supporting computed tomography (CT) images. For each injury, important radiologic descriptors are discussed which may need to be communicated to consultants. Aspects of management and follow-up imaging recommendations are included. This is a two-part review: Part 1 focuses on fracture eponyms of the upper extremity, while Part 2 covers fracture eponyms of the lower extremity.
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Affiliation(s)
- Philip Kin-Wai Wong
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road, Atlanta, GA, 30322, USA,
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18
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Veith NT, Knopp W, Pizanis A, Tschernig T, Pohlemann T, Mörsdorf P. [Not Available]. Chirurg 2015; 87:162-4. [PMID: 26016712 DOI: 10.1007/s00104-015-0025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- N T Veith
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland.
| | - W Knopp
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland
| | - A Pizanis
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland
| | - T Tschernig
- Institut für Anatomie und Zellbiologie, Universität des Saarlandes, 66421, Homburg, Deutschland
| | - T Pohlemann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland
| | - P Mörsdorf
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Straße 1, 66421, Homburg/Saar, Deutschland
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19
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Do the radial head prosthesis components fit with the anatomical structures of the proximal radioulnar joint? Surg Radiol Anat 2014; 37:743-7. [PMID: 25542245 DOI: 10.1007/s00276-014-1407-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The fitting accuracy of radial head components has been investigated in the capitulo-radial joint, and reduced contact after prosthetic replacement of the radial head has been observed. The kinematics of the proximal radioulnar joint (PRUJ) are affected by radial head arthroplasty as well, but have not yet been investigated in this regard. METHODS The elbow joints of 60 upper extremities of formalin-fixed body donors were disarticulated to obtain a good view of the PRUJ. Each specimen was mounted on the examining table and radial head position in the native PRUJ was assessed in neutral position, full pronation, and full supination. Measurements were repeated after implantation of mono- and bi-polar prostheses. RESULTS Analysis of the distribution of the joint contacts in the compartments showed significant differences after radial head replacement. In comparison to the native joint, after bipolar and monopolar radial head replacement, the physiological shift of the proximal radius was altered. DISCUSSION The physiological shift of the joint contact of the radial head from anterior to posterior during forearm rotation that was found in the native joint in our cadaver model was not observed after prosthetic replacement. With higher conformity and physiological kinematic of radial head prostheses, possibly lower shear forces and lower contact pressures would be generated. CLINICAL RELEVANCE The tested radial head prostheses do not replicate the physiological kinematics of the radial head. Further development in the prosthesis design has to be made. The meticulous reconstruction of the annular ligament seems to be of importance to increase joint contact.
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Grassmann JP, Hakimi M, Gehrmann SV, Betsch M, Kröpil P, Wild M, Windolf J, Jungbluth P. The treatment of the acute Essex-Lopresti injury. Bone Joint J 2014; 96-B:1385-91. [PMID: 25274926 DOI: 10.1302/0301-620x.96b10.33334] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Essex-Lopresti injury (ELI) of the forearm is a rare and serious condition which is often overlooked, leading to a poor outcome. The purpose of this retrospective case study was to establish whether early surgery can give good medium-term results. From a group of 295 patients with a fracture of the radial head, 12 patients were diagnosed with ELI on MRI which confirmed injury to the interosseous membrane (IOM) and ligament (IOL). They were treated by reduction and temporary Kirschner (K)-wire stabilisation of the distal radioulnar joint (DRUJ). In addition, eight patients had a radial head replacement, and two a radial head reconstruction. All patients were examined clinically and radiologically 59 months (25 to 90) after surgery when the mean Mayo Modified Wrist Score (MMWS) was 88.4 (78 to 94), the mean Mayo Elbow Performance Scores (MEPS) 86.7 (77 to 95) and the mean disabilities of arm, shoulder and hand (DASH) score 20.5 (16 to 31): all of these indicate a good outcome. In case of a high index of suspicion for ELI in patients with a radial head fracture, we recommend the following: confirmation of IOM and IOL injury with an early MRI scan; early surgery with reduction and temporary K-wire stabilisation of the DRUJ; preservation of the radial head if at all possible or replacement if not, and functional bracing in supination. This will increase the prospect of a good result, and avoid the complications of a missed diagnosis and the difficulties of late treatment.
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Affiliation(s)
- J P Grassmann
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - M Hakimi
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - S V Gehrmann
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - M Betsch
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - P Kröpil
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - M Wild
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - J Windolf
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - P Jungbluth
- University Hospital Duesseldorf, Department of Trauma and Hand surgery, Moorenstrasse 5, Duesseldorf, 40225, Germany
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Wegmann K, Engel K, Burkhart KJ, Ebinger M, Holz R, Brüggemann GP, Müller LP. Sequence of the Essex-Lopresti lesion--a high-speed video documentation and kinematic analysis. Acta Orthop 2014; 85:177-80. [PMID: 24479620 PMCID: PMC3967261 DOI: 10.3109/17453674.2014.887952] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The pathomechanics of the Essex-Lopresti lesion are not fully understood. We used human cadavers and documented the genesis of the injury with high-speed cameras. METHODS 4 formalin-fixed cadaveric specimens of human upper extremities were tested in a prototype, custom-made, drop-weight test bench. An axial high-energy impulse was applied and the development of the lesion was documented with 3 high-speed cameras. RESULTS The high-speed images showed a transversal movement of the radius and ulna, which moved away from each other in the transversal plane during the impact. This resulted into a transversal rupture of the interosseous membrane, starting in its central portion, and only then did the radius migrate proximally and fracture. The lesion proceeded to the dislocation of the distal radio-ulnar joint and then to a full-blown Essex-Lopresti lesion. INTERPRETATION Our findings indicate that fracture of the radial head may be preceded by at least partial lesions of the interosseous membrane in the course of high-energy axial trauma.
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Affiliation(s)
- Kilian Wegmann
- Department of Orthopaedic and Trauma Surgery, University Medical Centre
| | - Karsten Engel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Klaus J Burkhart
- Department of Orthopaedic and Trauma Surgery, University Medical Centre
| | - Marc Ebinger
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Robert Holz
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Lars P Müller
- Department of Orthopaedic and Trauma Surgery, University Medical Centre
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Mehta N, MacFarlane RJ, Brown D. Traumatic disorders of forearm rotation: anatomy, biomechanics and treatment. Br J Hosp Med (Lond) 2014; 75:72-7. [PMID: 24521801 DOI: 10.12968/hmed.2014.75.2.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The forearm is a complex structure which produces a wide range of movement. Forearm injuries are very common, but many injuries are missed or poorly treated. This article examines the anatomy and biomechanics of the forearm, and describes the important injuries to be recognized.
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Affiliation(s)
- Nisarg Mehta
- Foundation Year 1 Trainee, Wirral University Teaching Hospital NHS Trust, Liverpool
| | - Robert J MacFarlane
- Specialty Registrar in Trauma and Orthopaedic Surgery in the Department of Orthopaedics
| | - Daniel Brown
- Consultant Hand and Wrist Surgeon in the Liverpool Upper Limb Unit, The Royal Liverpool University Hospital, Liverpool
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McGlinn EP, Sebastin SJ, Chung KC. A historical perspective on the Essex-Lopresti injury. J Hand Surg Am 2013; 38:1599-606. [PMID: 23890499 PMCID: PMC4157731 DOI: 10.1016/j.jhsa.2013.04.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/21/2013] [Accepted: 04/23/2013] [Indexed: 02/02/2023]
Abstract
An Essex-Lopresti injury is a fracture of the radial head with concomitant dislocation of the distal radioulnar joint and rupture of the interosseous membrane. Poor outcomes have been associated with this rare injury if the dislocation of the distal radioulnar joint is missed in the acute setting. This injury is named after the British orthopedic surgeon Peter Essex-Lopresti, who made a number of important observations about this injury in 1951. Peter Essex-Lopresti was a promising young surgeon, and his untimely death at the age of 35 brought an early end to a remarkable career. This article investigates the evolution of treatment for this injury and sheds light on the life of the surgeon for whom the injury is named.
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Affiliation(s)
- Evan P. McGlinn
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
| | - Sandeep J. Sebastin
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Kevin C. Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System; Ann Arbor, MI
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24
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Die Radiuskopffraktur. ARTHROSKOPIE 2013. [DOI: 10.1007/s00142-012-0732-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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