Surgical treatment of Essex-Lopresti lesion combined with intraarticular fracture of distal radius

Abstract

Objective To explore the surgical treatment of Essex-Lopresti lesion combined with intraarticular fracture of distal radius. Methods From January 2005 to January 2014, we treated 8 patients with Essex-Lopresti lesion with intraarticular fracture of distal radius. They were 6 men and 2 women, 19 to 48 years of age (average, 35.7 years). According to the Mason-Johnston classification, there were 5 cases of type Ⅱ, one of type Ⅲ and 2 of type Ⅳ. By AO classification, there were 4 cases of type C1, 2 of type C2 and 2 of type C3. All patients received one stage operation to restore the radial length, anatomically reduce the articular surface of the radius, and reduce and stabilize the distal radioulnar joint. At the final follow-ups, the ranges of motion of the elbow, forearm, and wrist, Mayo Elbow Performance Score (MEPS) of the elbow, and the modified Green-O'Brien score of the wrist were recorded. Results All the patients were available for a mean follow-up of 20.6 months (range, from 13 to 36 months). Fractures healed within an average duration of 7.5 weeks (range, from 6 to 10 weeks). At the final follow-ups, the elbow flexion and extension ranged from 95° to 155° (average, 120.8°) , the forearm pronation and supination ranged from 85° to 145° (average, 120.6°) , and the wrist flexion and extension ranged from 85° to 135° (average, 125.5°). At the final follow-ups, the MEPS was excellent in 5 cases, good in 2, and fair in one. The modified Green-O'Brien wrist performance score was excellent in 5 cases, good in one, and fair in 2. No deep infection, nonunion or loosening of the internal fixator happened. Conclusions Essex-Lopresti lesion combined with intraarticular fracture of distal radius is likely misdiagnosed. Primary restoration of the length of distal radius, anatomical reduction of the articular surface of radius, and reduction and stabilization of the distal radioulnar joint can achieve good curative effects. Key words: Carpal joints; Elbow joint; Fracture fixation, internal; Essex-Lopresti lesion