To Reconstruct or Not: A Case of Acute Reconstruction of the Forearm Interosseous Membrane with CMC Mini Tight Rope

Essex Lopresti fractures are rare injuries of the forearm. Extent of damage to the interosseous membrane (IOM) in this setting is variable and can lead to disabling sequelae when not recognized and managed appropriately. While chronic reconstruction for longitudinal radioulnar dissociation is well studied, acute reconstruction of the membrane is infrequently documented and surgical techniques vary. There are only five documented cases of acute IOM reconstruction for Essex Lopresti injuries (ELIs). This is the first described case using a mini suture-button construct in conjunction with a radial head replacement and distal radioulnar joint (DRUJ) pinning, while also providing long-term radiographic and functional follow-up of 2 years.

We present a case of a 40-year-old male who sustained an Essex Lopresti fracture that was acutely recognized and surgically managed with a radial head replacement, DRUJ pinning, and acute reconstruction of the IOM with a Mini TightRope suture button construct. We also provide a post-operative rehabilitation protocol with early range of motion and pin removal. At our final 2-year postoperative follow-up, the patient demonstrated excellent functional outcomes.

This case illustrates that a CMC Mini TightRope can be used for acute reconstruction of the IOM in the setting of ELIs which allows for early range of motion and DRUJ pin removal due to the maintenance of longitudinal radioulnar reduction.