[Central band reconstruction in Essex-Lopresti lesions].

OBJECTIVE

Restoration of longitudinal forearm stability by reconstruction of the central band (CB) of the interosseous membrane (IOM) of the forearm.

INDICATIONS

Acute and chronic Essex-Lopresti lesions (EL) with longitudinal forearm instability.

CONTRAINDICATIONS

Absolute: acute/subacute infection. Relative: severe complex regional pain syndrome (CRPS), bony deformity/bone loss, pronounced osteoarthritis of the elbow and wrist.

SURGICAL TECHNIQUE

Ulnar approach with exposure of the ulna approximately 6 cm proximal to the ulnar styloid. Creation of a 3.5 mm drill hole from ulnar-distal to radial-proximal. A Fiberloop (Fa. Arthrex, Naples, FL, USA) is fixed to one end of the LARS (Ligament Advanced Reconstruction System, Fa. Corin Group, Cirencester, UK) in a whipstitch technique, is shuttled through the drill hole from radial to ulnar and fixed over a BicepsButton (Fa. Arthrex, Naples, FL, USA). Exposure of the radius through a modified Henry approach. A 3.5 mm drill hole is made from radial-proximal to ulnar-distal approximately 12 cm proximal to the radial styloid. The graft is shuttled from the ulnar to the radial incision directly on the palmar surface of the IOM and shortened to the required length. Another Fiberloop is used to perform a whipstitch on the free end of the LARS. The final fixation of the CB reconstruction is achieved by shuttling the Fiberloop sutures through the radial drill hole with fixation over a BicepsButton.

POSTOPERATIVE MANAGEMENT

Short-term immobilization in a long arm cast with subsequent early functional treatment.

RESULTS

Mediocre to poor clinical results are reported in the literature for the treatment of chronic EL. Future research will tell whether the advanced surgical techniques with CB reconstruction will lead to better clinical outcomes.