Essex-Lopresti Longitudinal Instability of the Forearm

Edinburgh Trauma Symposium 2016 - Identification and treatment of Essex-Lopresti Longitudinal Instability of the Forearm

1. Essex Lopresti Lesion:
Does it exist?
Adam C Watts
Consultant Elbow and Upper Limb Surgeon, Wrightington
Hospital
Visiting Professor, University of Manchester
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Peter Essex-Lopresti
Born 1916
Trained at Royal London
Hospital
Joined RAMC in WWII
Huntarian Professor
1951
Os calcis fracture
classification
Died suddenly aged 35
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Longitudinal -
Essex-Lopresti

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“Hidden Injury” - IOM
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Load transfer
Prevent radius and ulna
bowing
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Role of IOM

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How common is this lesion?
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a
d
c
b
c
b’
c

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Tightrope Reconstruction
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Bone-ligament-bone graft
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Ligament Augmentation and
Reconstruction System (LARS)
Polyester rope
Ultimate stress 2600N
Residual Strain at 2500N = 1.5%
Stiffness = 209N/mm (cf 129 native IOM)
No damage after 5 million cycles
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Experience to date
12 Procedures (chronic injuries) min follow-up 18
months
1 persistent axial instability - revised to OBF
No other recurrent proximal migration
Mean DASH improved 77 to 41/100
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Rare lesion after high energy axial load
Need to address soft tissue injury
Prognosis is generally poor
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Longitudinal Forearm Instability