Article
Essex Lopresti Fracture-Dislocation
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Published: | February 6, 2020 |
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Objectives/Interrogation: Essex-Lopresti injury is a rare entity that consists of a fracture of the radial head, rupture of the interosseous membrane and disruption of the distal radioulnar joint (DRUJ).
Methods: Case report.
Results and Conclusions: We report a case of a 34 year-old male that fell onto an outstretched right hand. He presented to the emergency department with elbow and wrist pain. Clinical examination revealed elbow swelling with tenderness and wrist and forearm pain with DRUJ compression test.
Plain radiographs revealed a comminuted radial head fracture and dorsal subluxation of the distal ulna.
Intraoperative wrist examination was compatible with wrist instability and elbow approach revealed a lateral collateral ligament (LCL) injury.
He underwent LCL repair, open reduction and internal fixation of the radial head with plate and screws. The DRUJ was reduced spontaneously and it was stable in all positions.
A long arm splint was applied in full supination and 90º of elbow flexion for 4 weeks and 2 weeks with munster - type elbow cast.
The patient returned to work 2 months after the surgery. At 6 months follow up he presented without pain. Clinical examination revealed full arc of pronosupination, full flexion and a deficit of 10º in extension.
This clinical report aims to highlight the importance of a careful examination of the wrist in all patients with displaced radial head fractures as the diagnosis can be often missed. Prompt diagnosis is mandatory for optimal outcome.