Falsely Reassuring Magnetic Resonance Imaging Appearance of the Forearm Interosseous Membrane following an Essex-Lopresti Injury: Does it Ever Completely Heal?

Abstract

The rare Essex-Lopresti injury classically involves the radial head, interosseous membrane and distal radioulnar joint. Treatment principles are to prevent proximal radial migration through reconstruction or replacement of the radial head. This case describes such an injury treated with metallic radial head prosthesis requiring later prosthesis removal. Magnetic resonance imaging (MRI) was conducted to investigate and reassure the treating surgeon of the integrity of the interosseous membrane. Despite the reassurance of MRI, the patient developed severe wrist symptoms because significant longitudinal displacement of the radius recurred. MRI is not a reliable determinant of integrity of the interosseous membrane in the forearm. It is clear from discussion amongst specialist upper limb surgeons that doubt exists regarding the potential for the membrane to heal and thereby restore its integrity. This fact is not clear in the literature but is of vital importance should the decision be made to remove the radial head, as illustrated particularly well in the present case.