Essex-Lopresti 813.05/833.01

 

 

synonyms:essex-lopresti, radial head fracture, elbow dislocation, radioulnar joint dislocation

Essex-Lopresti ICD-9

  • 813.05(closed fracture of head of radius)
  • 833.01 (closed dislocation, radioulnar joint, distal)

Essex-Lopresti Etiology / Epidemiology / Natural History

  • Radial head fracture or dislocation with complete disruption of the interosseous membrane and TFCC.DRUJ allowing proximal migration of the radius. (Esses-Lopresti P, JBJS 1951;33B;244).

Essex-Lopresti Anatomy

  • Primary stabilizer preventing proximal migration of the radius = the radial head. Secondary stabilizers = the interosseous ligament and the triangular fibrocartilage.

Essex-Lopresti Clinical Evaluation

Essex-Lopresti Xray / Diagnositc Tests

  • A/P, lateral and oblique elbow views and P/A, lateraland oblique wrist views indicated.
  • Radiocapitellar view is accomplished by positioning the patient as for a lateral x-ray view but angling the tube 45° toward the shoulder
  • Elevation of the anterior and postior fat pads(sail sign) indicates intraarticular hemarthrosis and may indicate non-displaced fx. Anterior fat pads are commonly seen. Posterior fat pad sign is associated with intraarticular fracture.
  • Bilateral PA views of both wrists in neutral rotation should be obtained to evaluate ulnar variance in patients with wrist pain.
  • CT can better delineate fracture configuration, but is generally not needed. 3D reconstructions can greatly enhance the pre-operative plan for complex fractures.

Essex-Lopresti Classification / Treatment

  • Acute: Treatment = ORIF of the radial head if possible, with immobilization of the forearm in supination. Comminuted non-repairable radial head fractures require replacement. May consider cross-pinning of the ulna (in suppination), or direct TFCC.
  • Chronic: patients which develope proximal migration of the radius following radial head excision. No recommened treatment has been established. Consider allograft radial head replacement (Szabo RM, J Hand Surg 1997;22A:269), or metal radial head replacement. Ulnar variance must be restored at surgery for optimal outcomes.

Essex-Lopresti Associated Injuries / Differential Diagnosis

Essex-Lopresti Complications

  • Contracture / stiffness(generally lack full extention)
  • Wrist pain (interossious ligament / DRUJ injury / TFCC injury).
  • Posttraumatic arthritis
  • Instability
  • Heterotopic ossification
  • Reported complications with radial head excision include loss of grip strength, pain at the wrist, valgus instability and posttraumatic arthritis of the trochlear-olecranon articulation.
  • AVN
  • Nonunion: (Ring D, CORR 2002;398:235).
  • Painful hardware

Essex-Lopresti Follow-up Care

  • Post-op: Splint with forearm in supination or neutral. Start early active range of motion as soon as possible. Consider Indomethacin 75mg QD/NSAIDs for patients with complex dislocations or Radial head replacement HOreduction.
  • 7-10 Days: Evaluate incision, remove stitches, Begin early active range of motion as soon as possible. Consider hinged elbow brace for high energy injuries/instability. Start physical therapy. Avoid flexion in pronation. Patients with Essex-Loprestic injuries are held in full supination for 3-4 weeks.
  • 6 Weeks: Consider static progressive nightime extension splinting if a flexion contracture is present 6 weeks after injury. 10° to 15° flexion contractures are not uncommon. If DRUJ treated by pinning remove pins at 6wks.
  • 3 Months: Progress with ROM. May take 6-12 months to regain ROM. Begin sport specific therapy.
  • 6 Months: May return to full activities provided patient is asymptomatic
  • 1Yr: Assess outcomes, repeat xrays.
  • Radial Head Rehab Protocol.
  • See also Elbow Outcome Measures.

Essex-Lopresti Review References

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