Secondary treatment for undetected Essex-Lopresti lesion

Aim: Essex-Lopresti lesion (ELL) consists of a radial head fracture in combination with a rupture of the interosseous membrane and a dislocation of the distal radioulnar joint. In the case of radial head resection proximal migration of the radius occurs. The aim of this retrospective study was to analyse the treatment and outcome for chronic ELL. Method: Altogether 6 patients with secondary ELL were detected and clinically reviewed. Therapy consisted of implantation of a silastic radial head prosthesis in 3 cases and ulna shortening in 2 other cases. One patient received both procedures. In two patients a Sauve-Kapandji procedure was performed 1.5/18 years later. Additional injuries were frequent. Results: Pain at the wrist improved in 5 cases and was unchanged in one case. Clinical results demonstrate a limited range of motion concerning the forearm rotation in all but one case (mean: 98degrees). Ulnar variance decreased from 5.2 mm to 2.7 mm postoperatively. Conclusion: Results of treatment for undetected Essex- Lopresti lesion are limited. Therefore in the case of a radial head fracture, meticulous examination of the distal radioulnar joint is recommended to detect an ELL.