Essex-Lopresti Injuries: A Systematic Review

Abstract

Essex-Lopresti injuries (ELIs) are rare, and complex forearm injuries involving radial head fracture, interosseous membrane (IOM) rupture, and distal radioulnar joint (DRUJ) instability. We performed a systematic review to define diagnostic criteria, explore treatment strategies, and evaluate clinical outcomes.

A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-guided systematic review was conducted using EMBASE, EMCARE, and MEDLINE. Thirty-five studies encompassing 156 adult ELI cases were included, spanning both acute and chronic presentations. Data extraction included demographics, diagnostic methods, injury characteristics, management strategies, and outcomes. Studies were assessed for definitional consistency and treatment approaches.

ELIs were often misdiagnosed, particularly in acute settings, contributing to a high rate of chronic instability. Most cases underwent surgical intervention, primarily targeting the radial head, with inconsistent attention to DRUJ and IOM repair. Radial head prosthesis, ulnar shortening osteotomy, and IOM reconstruction were more commonly applied in chronic cases. Conservative management was associated with poor outcomes unless applied to stable injury variants. Combined surgical interventions addressing multiple components of forearm stability yielded better outcomes, though variation in treatment approaches led to heterogeneity in results.

Early and accurate diagnosis is critical to prevent chronic instability and functional loss in ELI. Surgical treatment should comprehensively address radial head integrity, DRUJ stability, and IOM function. There is no universally accepted management algorithm, and optimal treatment requires a patient-specific, multicomponent approach. Delayed diagnoses correlate with increased need for complex revisions and poorer outcomes.

Systematic review of case reports and case series; Level IV evidence.