The Essex-Lopresti fracture is a

fracture Fracture is the separation of an object or material into two or more pieces under the action of stress. The fracture of a solid usually occurs due to the development of certain displacement discontinuity surfaces within the solid. If a displa ...

of the

radial head 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. The circumference of the head is smooth; it is broad medially where it articulates with the rad ...

of the forearm with concomitant dislocation of the distal radio-ulnar joint along with disruption of the thin

interosseous membrane An interosseous membrane is a thick dense fibrous sheet of connective tissue that spans the space between two bones, forming a type of syndesmosis joint. Interosseous membranes in the human body: * Interosseous membrane of forearm * Interosseous ...

which holds them together.Essex Lopresti fracture
at Wheeless' Textbook of Orthopaedics online The injury is named after

Peter Essex-Lopresti Peter Gordon Lawrence Essex-Lopresti FRCS Ed. (1916 – 13 June 1951) 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. Bi ...

who described it in 1951. Descriptive image link

Cause

This fracture typically occurs in patients who have fallen on an outstretched hand (a "FOOSH" injury).

Diagnosis

The injury can be difficult to diagnose initially as medical attention is usually 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 A subluxation is an incomplete or partial dislocation of a joint or organ. According to the World Health Organization (WHO), a subluxation is a "significant structural displacement", and is therefore always visible on static imaging studies, suc ...

of the

ulna The ulna (''pl''. ulnae or ulnas) is a long bone found in the forearm that stretches from the elbow to the smallest finger, and when in anatomical position, is found on the medial side of the forearm. That is, the ulna is on the same side of t ...

often seen on lateral view of the

pronated Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

wrist.

Management

The radial head fracture is usually managed by

open reduction internal fixation Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the m ...

under general anaesthesia: the area is opened surgically, the surgeon forces the bones back into their correct positions, and then fixes them in place using titanium pins and/ or plates; if the fracture is too comminuted (i.e., the bones have been crushed or fractured into many pieces) a radial head implant can be used. Excision/ removal of the radial head should be avoided, as over time this will cause the rest of the radius to migrate proximally leading to wrist pain and loss of pronation and

supination Motion, the process of movement, is described using specific anatomical terms. Motion includes movement of organs, joints, limbs, and specific sections of the body. The terminology used describes this motion according to its direction relative ...

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.

Outcomes

Most healthy individuals can recover from this type of injury within 10 weeks. However, as with most bone fractures, there is always the possibility of

malunion A malunion is when a fractured bone does not heal properly. Some ways that it shows is by having the bone being twisted, shorter, or bent. Malunions can occur by having the bones improperly aligned when immobilized, having the cast taken off to ...

between bone fragments.

References

External links

{{Fractures Bone fractures