Unstable Fractures of the Forearm: a project to improve clinical comprehension and to evaluate the results of the Interosseous Membrane Reconstruction

BACKGROUND: The Essex Lopresti lesion represents the worse pattern of the Unstable Fractures of the Forearm, because of the three constraints disruption, so it can be defined as the most challenging forearm lesion for the surgeon. All the Authors agree to consider acute treatment as absolutely necessary, pointing out the need for an early diagnosis. METHODS: I analyzed the Faenza Hospital Orthopedic Unit cases of Unstable Fractures of the Forearm: in the period 2010-2016, ten patients have been treated, all male, with a mean age of 37 years; all the injuries had been caused by high energy trauma. Eight cases were chronic Essex-Lopresti injuries, two cases were acute. All these patients undervent an Interosseous Membrane Reconstruction (IOM), with different devices (frozen allograft, LARS, Ethibond braid and Ultratape). RESULTS: At a mean follow up of 22 months, the mean ROM for the acute cases was 5-140° in flexion-extension, 68-0-66° in pronation and supionation, with no wrist functional limitations; the mean ROM in the chronic cases was 24-127 degrees in extension and flexion, 54-0-47 degrees in pronation and supination, 58-63° in wrist extension and flexion. At the same mean follow up, the mean MEPS was 89/100 points for the chronic cases and 97,5/100 for the two acute cases, confirming the improvement of the functional results in the acutly treated patients. CONCLUSIONS: The IOM plasty is a well planned technique and many Authors agree on its use both in acute and chronic conditions, but the results, in the Literature, are still exiguous and not homogeneous. Our encouraging data induce us to continue on the undertaken road, with the aim of validating the current surgical technique and, if possible, of improving it increasingly.