It is known that the delayed diagnosis of Essex-Lopresti injury can lead to devastating results concerning the function of the upper extremity. The aim of our study is to suggest methods of early diagnosis and treatment based on our experience on ten patients who were treated for this rare injury. We studied 10 patients (9 male and 1 female), average 36,5 years old (25–53) who sustained comminuted fracture of the radial head, isolated (3 patients) or with concomitant injury of the ipsilateral (3 patients) or the contralateral upper extremity (4 patients). Initially, 8 patients were treated with excision and 2 with internal fixation of the radial head and radioulnar transfixing pin. Gradually, they all developed subluxation of the DRUJ and they were treated for established Essex-Lopresti injury, 1–7 months after initial injury. Six patients were treated with reduction of radioulnar length (ulnar shortening osteotomy, with or without distraction with an external fixator) and TFC suturing. In 4 patients the radial head was replaced with a metallic implant, joint levelling and TFC suturing. The results were estimated after an average follow-up of 67 months (1–10 years) based on radiological (radioulnar equivalence) and clinical criteria (wrist and elbow range of motion, forearm rotation and grip strength). Excellent results were achieved in 4 patients who underwent metallic radial head replacement. Conversely, in the rest patients the radioulnar discrepancy relapsed in various degrees but the radiological result does not correlate with the clinical picture. We concluded that early diagnosis is necessary but not the only prerequisite for a good long-term result. Replacement of the radial head with titanium implant, offers good result at least in the short and mid-term period.
During the decade 1986–1996 were admitted in our hospital 2267 patients with hip fractures. From them 179 (7.98%) had already operated on for fracture to their other hip and the majority of them had a good way of life after the first operation. In 125 cases (69.83%) the second fracture was similar to the first. The mean age was 78.5 years. From the 179 patients, 145 were women and 34 men (rate 4.3/1). The 94 (52.5 %) were intertrochanteric and the other 85 (47.5%) subcabital fractures. The mean time between fractures was 6.5 years in patients under 70 years and decreased in those over 80 years in 3.5 years. On the bases of our follow up, mean time 18 months (12m–24m), from the 179 patients, 55 (30.7%) died during the first six months, (3 during hospitalization) and 13 (tot 37.98%) later but before our re-examination. The evaluation of the remaining 111 patients, according pain and activities of the patients was: 16 (14.3%) very good, 52 (47%) good and 43 (38.7%) fair. The patients with the better results were those under 75 years, who had similar hip fractures and had been operated on the first 3 days. In the other hand the majority of the 43 patients with the fair results were over 85 years. We found out that the bilateral non simultaneous hip fractures had a high mortality incidence. We believe that, except the age, there were other risk factors for this high mortality, such as, cardiovascular diseases, chest and urinary infections, bed sores etc. We noticed also that in all patients there was a decrease of the bone mass as a result of the extended immobilization and poor nutrition.
