Clinical Example: Ulnar shortening osteotomy for ulnar impaction Essex-Lopresti syndrome

The Essex-Lopresti syndrome may develop after a proximal radial fracture such as a radial head fracture, excision of the radial head for fracture, or a displaced proximal radial shaft fracture.  The Essex-Lopresti syndrome results when such a fracture, associated with disruption of the forearm interosseous membrane, allows proximal migration of the radius with secondary problems arising at the distal radial ulnar joint.

When recognized early, the problem may be prevented or at least lessened by anatomic fracture fixation or by radial head replacement with a metal radial head implant.  

Late reconstruction is difficult because of chronic changes in the forearm architecture, and options include ulnar shortening, distal ulnar resection, or graft reconstruction of the interosseous membrane.  Each of these approaches has its own problems, and recurrence may develop after any of these procedures. Fresh frozen allograft has also been reported for this use, (click here for reference)  but long-term outcome studies are still pending.

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This patient had undergone a radial head excision as primary treatment for his radial head fracture.
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Prior radial head excision.
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In this case, a significant length of ulna was removed. A longitudinal groove was made in the ulna and marked with ink prior to oblique osteotomy to aid confirmation of alignment for fixation. 

As might be expected, the ends of the ulna could not be easily brought together.repositioning of the distal ulna segment required an extensive exposure as detailed in 

this other case.
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Final appearance of healed osteotomy.
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Restoration of normal ulnar length.
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Another view of the entire forearm.
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