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Intraosseous membrane reconstruction of Essex-Lopresti injuries satisfactory at 10 years
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Patients with chronic Essex-Lopresti injuries who underwent interosseous membrane reconstruction with a bone-patellar tendon-bone graft combined with ulnar shortening osteotomy experienced satisfactory clinical and functional results, according to findings published in the Journal of Bone and Joint Surgery.
“If you look at prior studies on the treatment of chronic Essex-Lopresti lesions, the results have been suboptimal long-term. So, now we have a procedure we know will provide forearm stability and maintain that stability over a 10-year period,” Randall W. Culp, MD, of Philadelphia Hand and Shoulder Center, told Orthopedics Today.
Culp and colleagues obtained preinjury clinical examination and radiographic measurements of 33 patients who underwent interosseous membrane (IOM) reconstruction using bone-patellar tendon-bone graft for chronic Essex-Lopresti injuries. These measurements were compared with prospectively collected data. Postoperatively, researchers collected QuickDASH, modified Mayo wrist and Broberg-Morrey elbow function scores.
Significant improvement was seen in mean elbow flexion-extension arc, wrist flexion-extension arc, forearm pronation-supination and grip strength at a mean 10-year follow-up. There was significant improvement in ulnar variance from preoperative examination to immediately postoperatively (+3.9 mm vs. –1.6 mm). Ulnar variance declined to –1.1 mm at final follow-up. Patients had a mean QuickDASH score of 29.8, a mean modified Mayo wrist score of 82.7 and a mean Broberg-Morrey score of 91.6. Researchers found 33% of patients had complications that required additional surgery. The most common symptoms were related to ulnar shortening osteotomy hardware that either required removal or was associated with nonunion at the site of the osteotomy, according to the results.
“One of the problems with Essex-Lopresti lesions is an ulnar-positive variant that leads to ulnar impaction. Ulnar shortening osteotomies for these patients, combined with IOM reconstruction, demonstrated a stable ulnar variance at the 10-year follow-up,” Culp, an Orthopedics Today Editorial Board member, said. “That was one of the elements of the reconstruction I was most concerned with. I was worried when we did the ulnar shortenings they would return to their prior position, and they did not.”
Prevention of chronic Essex-Lopresti injuries is key, according to Culp, who notes better outcomes with acute Essex-Lopresti injuries when compared to chronic injuries. Research that helps orthopedic surgeons identify acute Essex-Lopresti injuries radiographically and through physical examination may result in earlier treatment, which may prevent some problems, Culp said.
“I also think there is going to be some role for looking at the use of synthetic interosseous membrane reconstructions as opposed to allograft bone-patellar-bone,” Culp said. “For example, there are some suture-button complexes being made that are being looked at to reconstruct the interosseous membrane and I think there is going to be some research emphasis on those, as well.” – by Casey Tingle
- Reference:
- Gaspar MP, et al. J Bone Joint Surg Am. 2018;doi:10.2106/JBJS.17.00820.
- For more information:
- Randall W. Culp, MD, can be reached at The Franklin, Suite G114, 834 Chestnut St., Philadelphia, PA 19107; email: rwculp@handcenters.com.
Disclosure: Culp reports no relevant financial disclosures.