A primarily overlooked and incorrectly treated Essex-Lopresti injury: what can this lead to?

Abstract

What result can one expect in treating an Essex-Lopresti lesion--a rare complex combination injury of the forearm consisting of a radial head fracture and a rupture of the interosseous membrane--which failed to be identified at first? We report on a 45-year-old poly traumatized patient in which a primary Essex-Lopresti injury was overlooked following a dislocated radial head fracture. A radial head resection followed by an ulna-shortening osteotomy was performed with disastrous consequences at another clinic. As a result of persistent instability in the distal radioulnar joint, we implanted a mono-polar radial head prosthesis, which was subsequently changed as a result of a loosening of the prosthesis and persistent complex instability and pain in the area of the entire forearm, while an ulna osteotomy had to be carried out to correct this. This prosthesis also loosened, which destroyed the capitulum humeri. It was only after a specially designed modular radial head prosthesis with a capitulum shield was implanted and an elapse of 5(1/2) years of the illness that permanent stability could be achieved on the forearm and the pain experienced by the patient eliminated while at the same time the patient regained a moderate degree of functioning and grip strength. An overlooked primary and ultimately initially incorrectly treated Essex-Lopresti injury can degenerate into a real therapeutic disaster. Years of illness and multiple corrective operations which only serve to limit the collateral damage caused by the wrong therapy strategy and ultimately only lead to restoration of moderate function. The crucial factor is an early diagnosis. Then a radial head prosthesis should first be implanted in an operation in order to prevent an additional proximal migration of the radius and to move the distal radioulnar joint into the proper anatomical position.