[The Essex-Lopresti forearm fracture (case report)].

Abstract The radial head fracture associated with dislocation in the distal end of the ulna and tear of interosseous membrane of the forearm with a subsequent proximal migration of the radial shaft is a relatively rare injury. For the first time it was described by Essex-Lopresti in 1951. Our report presents one case together with an analysis of available literature relating to the diagnosis and treatment. A man, 69 years old, hurt his right elbow and forearm in a fall on the outstretched arm. There was a 2 x 1 cm excoriation on the lateral portion of the elbow and a dominating pain and limitation of the range of motion of the right elbow and wrist. The radiograph of the elbow, forearm and wrist showed a dislocated comminuted fracture of the radial head, dorsal subluxation of the ulnar and proximal displacement of radius. The condition was assessed as Essex-Lopresti fracture of the forearm indicated for surgery. The four-fragment fracture of the radial head did not allow reconstruction and therefore the head was resected. Subsequently the distal radio-ulnar joint was revised from dorsal approach with a K-wire inserted transversally. In order to prevent proximal displacement of the radius a K-wire was inserted in the medullary cavity of the radius close to the distal end of the humerus with the elbow in 90 degrees flexion and slight supination. The wounds were sutured and plaster of Paris applied extending across the elbow up to the metacarpal heads. After 6 weeks the plaster fixation and K-wires were removed. Full weight bearing was permitted 4 months after the surgery. Ten months after the surgery the patient was without complaints. Flexion in the elbow ranged between 0-5-130 degrees, pronation-supination was limited by 10 degrees in both extreme positions. The ulnar head became prominent on the dorsal side, dorsiflextion and ulnar duction in the wrist were limited to 10 degrees. The radiograph of the wrist showed and evident proximal displacement of the radius, the dorsally subluxated ulnar head overhung by 7 mm. Our case has confirmed that a mere extirpation of the head with a subsequent stabilization and transfixation of the proximal end of the radius and transfixation of the distal radio-ulnar joint cannot prevent after the extraction of wires a proximal displacement of the radius and development of the "plus variant" resulting in the limitation of both the range of motion of the wrist and the pronation-supination movement of the forearm.