![]() (1992) The Journal of bone and joint surgery. Trousdale RT, Amadio PC, Cooney WP, Morrey BF. Masouros PT, Apergis EP, Babis GC, Pernientakis SS, Igoumenou VG, Mavrogenis AF, Nikolaou VS. It is named after Peter Gordon Essex-Lopresti (1916-1951), a trauma surgeon at Birmingham accident hospital, England 2. type III: radial head replacement and ulnar shortening osteotomy.type II: radial head excision and prosthetic replacement.type I: open reduction and internal fixation.The proposed treatment may be based on classification type 5. A recent study found that radial head replacement with the reconstruction of the interosseous membranes and central band restores radioulnar displacement and ulna forces to near normal 3. The low incidence, late presentations and heterogeneity in study samples presented in the literature preclude researchers reaching safe conclusions and planning of clinical studies 3. There have been historically poor outcomes in the treatment of longitudinal forearm instability which is particularly complex in the chronic setting 3. Initial radiographs may be unremarkable for Essex-Lopresti fracture-dislocations 6. If not recognized acutely, chronic instability and proximal migration of the radius results in ulna abutment with increased force transmission across the ulnocarpal joint 4. Rupture of the interosseous membrane results in perturbed transmission of force from the radius to the ulna 7. type III: chronic injury with proximal migration of the radial head.The proposed classification of Essex-Lopresti fracture-dislocation is based on the severity of radial head fracture 5. Radiocapitellar impingement due to longitudinal instability may cause lateral elbow pain 4. The distal radioulnar joint injury may be missed, leading to permanent wrist pain and stiffness or instability. As a result, there is axial and longitudinal loading that causes pain and instability. This usually occurs from a fall or high energy trauma with the elbow extended 4. The injury occurs due to the compressive force of trauma transmitted down the forearm through the proximal and distal radioulnar joints and the interosseous membrane 3,4. Purely a motor syndrome resulting in finger drop, and radial wrist deviation on extension.As little as 20% of Essex-Lopresti fracture-dislocations are recognized at the time of initial presentation 6.Posterior Interosseous Neuropathy (PIN) - radial nerve branch affects ~10% of Monteggia fractures.Consider open fracture (look for puncture wounds).If splinted and stabilized, can be discharged after consultation with Ortho.Long arm posterior splint with 90 degrees of elbow flexion and the hand in a neutral position.Findings: Radial head dislocation + proximal ulna fracture or plastic deformation of the ulna without obvious fracture.Assess radiocapitellar line on every lateral radiograph of the elbow: a line down the radial shaft should pass through the center of the capitellar ossification center. ![]() Radial head can dislocate anterior, posterior, or laterally.proximal 1/3 Ulna fracture + radial head dislocation (due to ulna shortening).CT scan: Fractures involving coronoid, olecranon, and radial head.Xray: AP, Lateral of elbow, forearm, wrist.PIN neuropathy most commonly associated (hand deviates radially with wrist extension).Decreased ROM at elbow may indicate dislocation.X-ray of Monteggia fracture of right forearm, showing fracture of ulna and dislocation of radius. May be associated with radial nerve injury (wrist drop, inability to extend the fingers)ĭifferential Diagnosis Forearm Fracture Types.Spontaneous relocation possible: must palpate directly over.Radial head may be palpable in an anterolateral or posterolateral location.Easy to overlook the radial head dislocation (will result in worse outcome).Common in kids (different treatment for kids) rare in adults.Proximal ulna fx with radial head dislocation.
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