Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury

Abstract

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury. Methods From March 2012 to December 2015, 5 patients with established Essex-Lopresti injury, whose radiuses had moved proximally since radial head had been resected in the earlier operation, were operated in our department, including 4 males and 1 female, aged from 25 to 50 years (average, 38.8 years). The interval from the radial head resection to the operation in our department was 2 to 7 months (average, 4.6 months). All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress, and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint. 2 of the 5 cases acquired distal radial-ulnar joint stability after reduction, and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks. The Mayo elbow and wrist function score were used to evaluate pre- and post-operative function, with recording the range of motion of the elbow, forearm and wrist. Results All the 5 patients were followed-up for 24 to 60 months (average 45 months). The Mayo elbow function score was improved from preoperative 62 (range, 45-75) to 96 (range, 80-100) at the latest follow-up. The Mayo wrist functional score was improved from 54 (range, 15-65) to 81 (range, 55-90) at the latest follow-up. All patients got significant improvement of involved upper extremity function, without proximal shifting of radius, radial head prosthesis failure or instability of the distal radio-ulnar joint. Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary. Key words: Radius fractures; Dislocations; Arthroplasty, replacement; Osteotomy