Treatment of Longitudinal Radioulnar Instability:Essex Lopresti lesion

June 1st, 2007

When a fall on an outstretched hand leads to a comminuted radial head fracture, longitudinal radioulnar dissociation (LRUD) may result if the forearm interosseous ligament (IOL) tears as well. This is often referred to as the Essex-Lopresti lesion, and treatment has been very unsatisfactory, historically. While I worked at the University of Pittsburgh, earlier in my career, I was priviledged to work with talented engineers/scientists who helped me learn more about the biomechanics at work. This has allowed us to learn more about why past treatments have failed.
Our research/publications have led to a change in treatment, which includes radial head replacement at the elbow, and TFCC repair at the wrist. In order to restore load transfer to normal--at the elbow--IOL reconstruction is now feasible. This intervention is still somewhat experimental, but our knowledge of the biomechanics suggests that long-term success of radial head replacement will require that the IOL be reconstructed.
Related Photos:
The Essex-lopresti injury results from an axial load to the arm. The IOL tears, resulting in a radial head fracture and proximal migration of the radius
AP wrist xray shows that the DRUJ is injured and that the ulna is long because of proximal migration of the radius
AP elbow xray shows the radial head fracture
IOL reconstruction is performed so that load can be transferred away from the radial head at the elbow; this will result is better long-term results of radial head replacement
Lateral xray of the elbow after radial head replacement. This restores normal length relationship at the wrist between the ulna and the radius. IOL reconstruction addresses the biomechanical issues