The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

Journal of hand and microsurgery

article

Svenna H. W. L. Verhiel¹  Sezai Özkan¹  Christopher G. Langhammer¹  Neal C. Chen¹ 

[1] Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School

关键词: distal radioulnar joint disruption;    Essex-Lopresti;    interosseous membrane rupture;    longitudinal forearm dissociation;   

DOI  :  10.1055/s-0039-3401380

学科分类：外科医学

来源: Thieme Medical and Scientific Publishers Pvt. Ltd.

【 摘 要 】

Objective  The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design  Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients  Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention  Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure  Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results  Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0–12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33–38). Median NRS score for pain-severity on average was 5 (IQR: 0–6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5–8). Conclusion  Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

【 授权许可】

CC BY