Sequence of the Essex-Lopresti lesion‣a high-speed video documentation and kinematic analysis

Abstract

Sir—It was with great interest that we read the paper by Wegmann et al. 2014) “Sequence of the Essex-Lopresti lesion—a high-speed video documentation and kinematic analysis”. We wish to congratulate the authors on their excellent work. These findings add to our knowledge and understanding of the pathobiomechanics of this rare lesion, with a demonstration 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. However, we have some concerns regarding the pathobiomechanics described by the authors, and wish to share them with the author. In our previous experience of diagnosing and treating patients with Essex-Lopresti lesions, all patients presented with radial head fracture, rupture of the interosseous membrane and disruption to the distal radio-ulnar joint. But in any Essex-Lopresti lesion, injury to one component is generally more severe than that to the other two. The radial head fracture is usually the most severely injured in these types of high-energy trauma in young patients with good bone quality. By comparison, the most severe injury in older patients occurs to the interosseous membrane; we have yet to ascertain an association for injury to the distal radio-ulnar joint in patient populations. We assume that the interosseous membrane in older patients is fragile, and that, when ruptured, it progresses into an Essex-Lopresti lesion, which is subsequently followed by radial head fracture. This hypothesis happens to be confirmed by the current study by Wegmann and co-workers, as they tested four specimens from volunteer donors with an average age of 84 (74–91) years. Therefore, our other hypothesis—that the interosseous membrane in younger patients is very strong and that the radial head will likely fracture before rupture of the interosseous membrane—could be further confirmed by similar mechanical experiments. Together, we infer from these experiments that there is no strict sequence for the development of the Essex-Lopresti lesion.