Essex-Lopresti fracture
Encyclopedia
The Essex-Lopresti fracture is a fracture
of the radial head
with concomitant dislocation of the distal radio-ulnar joint
with disruption of the interosseous membrane
. The injury is named after Peter Essex-Lopresti
who described it in 1951.
wrist.
of the wrist. Delayed treatment of the radial head fracture will also lead to proximal migration of the radius.
The distal radio-ulnar joint dislocation can be reduced by supination of the forearm, and may be pinned in place for 6 weeks to allow healing of the interosseous membrane.
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
of the radial head
Head of radius
The head of the radius has a cylindrical form, and on its upper surface is a shallow cup or fovea for articulation with the capitulum of the humerus....
with concomitant dislocation of the distal radio-ulnar joint
Distal radioulnar articulation
The distal radioulnar articulation is a pivot-joint formed between the head of the ulna and the ulnar notch on the distal radius.-Ligaments:The articular surfaces are connected together by the following ligaments:...
with disruption of the interosseous membrane
Interosseous membrane of the forearm
The interosseous membrane of the forearm is a fibrous sheet that connects the radius and the ulna...
. The injury is named after Peter Essex-Lopresti
Peter Essex-Lopresti
Peter Gordon Lawrence Essex-Lopresti FRCS Ed. was a British orthopaedic surgeon remembered for describing the Essex-Lopresti fracture and for his work on classification and treatment of fractures of the calcaneus.- Biography :...
who described it in 1951.
Diagnosis
The injury can be difficult to diagnose initially as the attention is focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked. The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronatedPronation
In anatomy, pronation is a rotational movement of the forearm at the radioulnar joint, or of the foot at the subtalar and talocalcaneonavicular joints. For the forearm, when standing in the anatomical position, pronation will move the palm of the hand from an anterior-facing position to a...
wrist.
Management
The radial head fracture is usually managed by open reduction internal fixation; if the fracture is too comminuted, a radial head implant can be used. Excision of the radial head should be avoided, as the radius will migrate proximally leading to wrist pain and loss of pronation and supinationSupination
Supination is a position of either the forearm or foot; in the forearm when the palm faces anteriorly, or faces up . Supination in the foot occurs when a person appears "bow-legged" with their weight supported primarily on the anterior of their feet.The hand is supine in the anatomical position...
of the wrist. Delayed treatment of the radial head fracture will also lead to proximal migration of the radius.
The distal radio-ulnar joint dislocation can be reduced by supination of the forearm, and may be pinned in place for 6 weeks to allow healing of the interosseous membrane.