Sequelae of an acute Essex Lopresti lesion: a case report

the forearm is considered a joint in itself where the ulna and radius interact. It is composed of the proximal radioulnar joint (PRUJ), the interosseous membrane (IOM), with the central band as the main component, and the distal radioulnar joint (DRUJ), which includes the triangular fibrocartilage complex (TFCC). Essex-Lopresti lesion (ELL) is a complex injury caused by axial forearm loading, leading to longitudinal radioulnar dissociation and stability loss due to IOM rupture, PRUJ injury with radial head involvement, and DRUJ injury with TFCC involvement. Early diagnosis is crucial as treating chronic injuries poses a significant challenge.

to describe chronic ELL, review the literature, and share treatment experience.

we describe the case of a 30-year-old male patient with a history of a motorcycle accident in 2019, initially diagnosed as a comminuted radial head fracture and treated with its resection at another center. He presented to our center in June 2023, complaining of wrist pain and a reducible but unstable dorsal ulnar protrusion. He had no elbow or forearm pain and had a full range of motion. Complementary tests (X-rays, CT scans, and MRI) showed a positive ulnar variance, a dorsal ulnar subluxation at the wrist and a TFCC lesion, without evidence of acute rupture of the IOM. An examination under anesthesia and fluoroscopic evaluation was performed to examine the stability and range of motion of the elbow and ARCD, as well as longitudinal stability of the forearm by traction, with no longitudinal instability observed. After considering the longitudinal stability of the forearm A 10 mm ulnar shortening osteotomy was performed and fixed with a plate and screws (FreeFix® SKDynamics). Arthroscopically, the TFCC was disinserted and reinserted using a modification of the Mantovani technique. It was immobilized with a Münster splint. At six-month follow-up, he has a VAS of 0 at the elbow and wrist, and a dorsal flexion/ volar flexion of 80o/80o, and a supination/pronation deficit of 10o/10o.

ELL is a rare but challenging pathology for orthopaedic surgeons. Therapeutic options include various surgical interventions, with ulnar shortening with TFCC repair being a viable option in chronic cases without longitudinal instability.