Surgical treatment of chronic longitudinal radioulnar dissociation (Essex-Lopresti injury)

Introduction An Essex-Lopresti lesion is a fracture of the radial head and a rupture of the interosseous membrane of the forearm, resulting in disruption of the longitudinal relationship between the radius and ulna, leading to longitudinal radioulnar dissociation. Most Essex-Lopresti injuries are diagnosed late, and surgical treatment is challenging even for an experienced orthopaedic surgeon. The objective was to demonstrate and analyze the results of multicomponent surgical treatment first applied for a patient with a chronic Essex-Lopresti injury. Material and methods A 29-year-old patient was diagnosed with a chronic Essex-Lopresti injury first treated with multicomponent surgical treatment including replacement of the radial head, Adams – Berger ligament reconstruction for the distal radioulnar joint, ulnar corrective shortening osteotomy, interosseous membrane reconstruction using synthetic graft, lateral ulnar collateral ligament reconstruction with an autograft. Results Pain improved and range of motion increased in adjacent joints at six months. A follow-up X-ray of the forearm showed a consolidating fracture of the ulna. Discussion Multicomponent surgical treatment of chronic Essex-Lopresti injury ensures restoration of the anatomical relationships of the forearm bones and correction of associated ligamentous injuries improving clinical and functional outcomes even with delayed treatment. Early diagnosis and timely reconstruction of the forearm structures are essential for prevention of irreversible changes providing functionality of the upper limb. Conclusion The study demonstrated the potential of a multi-component surgical approach as a single-stage treatment for patients with chronic Essex-Lopresti injury.