Chronic Essex-Lopresti injury: a systematic review of current treatment options

Elbow Dislocation With Associated Essex-Lopresti Injury: A Case Treated Conservatively

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.

Acute Essex-Lopresti Syndrome: About a Case of Brachioradialis Tendon Transfer

Background  The classic treatment for acute Essex-Lopresti syndrome is closed reduction percutaneous pinning (CRPP) of the distal radioulnar joint (DRUJ). This work aimed to verify whether it was possible to add a transfer of the brachioradialis tendon to the pinning. Case Description  The patient was a 39-year-old right-handed man, climbing instructor, who sustained the Mason II fracture and disjunction of the DRUJ. A transfer of the brachioradialis tendon severed from its muscle attach that was made through a bone tunnel passing through the radius and the neck of the ulna. The clinical and radiological result at the 6-month follow-up was satisfactory. Literature Review and Clinical Relevance  Our results in a single case showed that the brachioradialis tendon transfer was useful in acute Essex-Lopresti syndrome.

The "floating ulna" injury in adults: a case report, literature review and proposed injury classification

BACKGROUND

Ipsilateral Galeazzi fracture with elbow dislocation, namely the "floating ulna" injury, is a rare injury pattern. A few reports have described this type of injury and its treatment.

CASE PRESENTATION

A 33-year-old female at 38+ weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. At the 12-month follow-up, the patient had no pain or signs of instability. Range of motion was 0-135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm.

CONCLUSION

The "floating ulna" injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1-2 m in high-energy trauma.

Fracture-dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system

BACKGROUND

Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture-dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture-dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts.

METHODS

A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture-dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture-dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures].

RESULTS

Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture-dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture-dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors' knowledge, allowed us to include all types of dislocation and fracture-dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture-dislocations) of the forearm joint.

CONCLUSIONS

All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture-dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment.

LEVEL OF EVIDENCE

V.