Sheth Mihir, Mitchell Scott, Bell Bryce, Wu Chia
Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas.
Department of Orthopedic Surgery, Texas Children's Hospital, Houston, Texas.
JBJS Rev. 2022 Mar 3;10(3):01874474-202203000-00006. doi: e21.00212.
»: An Essex-Lopresti injury (ELI) is classically described as a radial head fracture with a concomitant interosseous ligament complex (IOC) injury. However, multiple injury patterns may be present, and an interosseous membrane (IOM) injury should be evaluated for in any axial load injury through the forearm. ELI may result in longitudinal radioulnar instability (LRUI).
»: Diagnosis of an IOC injury can be difficult. Evaluation begins with standard wrist and elbow radiographs and is supplemented with radiographs and intraoperative maneuvers to assess for proximal radial migration. Magnetic resonance imaging and ultrasonography may be useful in the acute setting, although indications and the clinical importance of the findings remain unclear.
»: Surgical management of an acute ELI is focused on restoration of radial length and temporary distal radioulnar joint (DRUJ) stabilization. Radial head excision in the acute setting should be approached with caution because proximal migration may not be present acutely but may develop over time. The indication for acute IOM repair and reconstruction remains unclear.
»: Surgical management of a chronic ELI is focused on restoration of radial length, wrist leveling, and treatment of degenerative changes (either at the radiocapitellar joint or the DRUJ). Reconstruction of the central band can restore forearm load transfer and produce favorable functional outcomes, but its indications continue to be debated.
埃克塞斯-洛普雷斯蒂损伤（ELI）通常被描述为伴有骨间韧带复合体（IOC）损伤的桡骨头骨折。然而，可能存在多种损伤模式，对于任何经前臂的轴向负荷损伤，都应评估骨间膜（IOM）损伤情况。ELI可能导致桡尺骨纵向不稳定（LRUI）。
IOC损伤的诊断可能具有挑战性。评估首先从标准的腕部和肘部X线片开始，并辅以X线片和术中操作以评估桡骨近端移位情况。磁共振成像和超声检查在急性期可能有用，尽管其指征和检查结果的临床意义仍不明确。
急性ELI的手术治疗重点在于恢复桡骨长度和临时稳定下尺桡关节（DRUJ）。在急性期进行桡骨头切除应谨慎，因为急性时可能不存在近端移位，但随着时间推移可能会出现。急性IOM修复和重建的指征仍不明确。
慢性ELI的手术治疗重点在于恢复桡骨长度、矫正腕部水平以及治疗退变改变（无论是在桡骨头关节还是DRUJ）。中央束的重建可恢复前臂负荷传递并产生良好的功能结果，但其指征仍存在争议。
