Like other traumatic patterns, this lesion can be classified in the group of unstable fractures of the forearm, characterized by fracture of one or both forearm bones associated with lesion of some forearm main constraints (TFCC, IOM and RH). After Essex-Lopresti detailed description, this injury pattern gained the eponym of Essex-Lopresti Injury (ELI). This longitudinal migration of the radius can generate when a traumatic axial load is transmitted from the wrist to the elbow, causing the combination of DRUJ disruption, rupture of the IOM and RH fracture. In 1951 Peter Essex-Lopresti described the proximal migration of the radius following the surgical excision of comminuted RH fracture. All these anatomic and functional structures can be grouped under the name of the Forearm Unit. The forearm constraints are formed by the Proximal Radio-Ulnar Joint (PRUJ) mainly represented by the Radial Head (RH), the Interosseous Membrane (IOM) particularly in its central and stronger part named Central Band or Interosseous ligament (IOL) and Distal Radio-Ulnar joint (DRUJ) represented by the Triangular Fibrocartilage Complex (TFCC) and, when present, by the Distal Oblique Band (DOB). All of these functions, especially pronation and supination, explain the complex integrated relationship between the bones and soft tissue along the entire length of this anatomical district. The forearm can be considered as a single articulating unit where the close interdependence of multiple anatomical structures allows forearm rotation, elbow and wrist motion. Conclusionsįollowing the observations, the definitions of “Acute Engaged” and “Undetected at Imminent Evolution” injuries are proposed to distinguish between evident cases and more insidious settings, with necessity of carefully investigate the anatomical and radiological features in order to address patients to an early and proper surgical treatment. In this study, the definitions of “Acute Engaged” and “Undetected at Imminent Evolution” Essex-Lopresti injury are proposed, in order to underline the necessity to carefully investigate the anatomical and radiological features in order to perform an early and proper surgical treatment. The clinical studies present in literature reported similar results, highlighting as patients properly diagnosed and treated in acute setting report better results than patients operated after four weeks. One case complained persistent wrist pain associated to DRUJ discrepancy of 3 mm and underwent ulnar shortening osteotomy nine months after surgery, with good results. Patients were followed for a mean of 15 months: a consistent improvement of clinical results were observed, reporting a mean MEPS of 92 and a mean MMWS of 90.8. ResultsĪll patients were operated in acute setting with radial head replacement and different combinations of interosseous membrane reconstruction and distal radio-ulnar joint stabilization. 42 articles were evaluated, and finally four papers were considered for the review. The search was limited to English language literature. A literature search was performed using Ovid Medline, Ovid Embase, Scopus and Cochrane Library and the Medical Subject Headings vocabulary. ELI was caused in two patients by bike fall, two cases by road traffic accident and one patient by fall while walking. Methodsįive patients affected by acute Essex-Lopresti injury have been enrolled for this study. Aim of this study is to focus on the different lesion patterns causing forearm instability, reviewing literature and the cases treated by the Authors and to propose a new terminology for their identification. When early diagnosed, patients report better outcomes with higher functional recovery. Acute Essex-Lopresti injury is a rare and disabling condition of longitudinal instability of the forearm.
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