Essex-Lopresti fracture: Difference between revisions
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==Evaluation== | ==Evaluation== | ||
[[File:PMC3967261 ORT-85-177-g001.png|thumb|Essex-Lopresti fracture with radial head fracture (left) and dorsal subluxation of the ulna (right).]] | |||
===Workup=== | ===Workup=== | ||
*PA and lateral radiography of the elbow and forearm (may only show a [[radial head fracture]]) | *PA and lateral radiography of the elbow and forearm (may only show a [[radial head fracture]]) | ||
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*The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. | *The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. | ||
*Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist | *Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist | ||
*Radial pull test: > 3mm displacement dorsal/volar is consistent with Essex-Lopresti | *Radial pull test: >3mm displacement dorsal/volar is consistent with Essex-Lopresti | ||
*May require CT to evaluate subtle fractures | *May require CT to evaluate subtle fractures | ||
Latest revision as of 07:03, 17 May 2019
Background
- Triad of radial head fracture, disruption of interosseous membrane, and distal radioulnar joint disruption
Clinical Features
- Unstable and painful forearm
- Axial force from wrist to elbow after fall on outstretched hand
- Grip weakness and difficulty pronating wrist
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
Workup
- PA and lateral radiography of the elbow and forearm (may only show a radial head fracture)
Diagnosis
- The injury can be difficult to diagnose initially, as the attention is focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked.
- The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma.
- Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist
- Radial pull test: >3mm displacement dorsal/volar is consistent with Essex-Lopresti
- May require CT to evaluate subtle fractures
Management
- Orthopedic referral
Disposition
- Per ortho - usually outpatient operative management (radial head arthroplasty)
See Also
External Links
References
- Williams D. Wrist and forearm. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2014.
- https://www.orthobullets.com/trauma/1019/radial-head-fractures