Radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury / 中华骨科杂志

ABSTRACT

Objective To investigate the effect of radial head replacement with metal prosthesis and reduction with stabilization of the distal radio-ulnar joint as a treatment of established Essex-Lopresti injury.Methods From March 2012 to December 2015,5 patients with established Essex-Lopresti injury,whose radiuses had moved proximally since radial head had been resected in the earlier operation,were operated in our department,including 4 males and 1 female,aged from 25 to 50 years (average,38.8 years).The interval from the radial head resection to the operation in our department was 2 to 7 months (average,4.6 months).All the 5 patients were operated with radial head replacement with metal prosthesis under no longitudinal stress,and 4 of them got distal ulnar shortening for reduction of the distal radio-ulnar joint.2 of the 5 cases acquired distal radial-ulnar joint stability after reduction,and the other 3 could not acquired stability and needed open reduction and repairing ligament structure of the wrist and pinning fixation for 4-6 weeks.The Mayo elbow and wrist function score were used to evaluate pre-and post-operative function,with recording the range of motion of the elbow,forearm and wrist.Results All the 5 patients were followed-up for 24 to 60 months (average 45 months).The Mayo elbow function score was improved from preoperative 62 (range,45-75) to 96 (range,80-100) at the latest follow-up.The Mayo wrist functional score was improved from 54 (range,15-65) to 81 (range,55-90) at the latest follow-up.All patients got significant improvement of involved upper extremity function,without proximal shifting of radius,radial head prosthesis failure or instability of the distal radio-ulnar joint.Conclusion It is effective for treatment of established Essex-Lopresti injury to replace radial head with metal prosthesis and to reduce and stabilize the distal radio-ulnar joint with distal ulnar shortening while necessary.