![]() Delayed treatment of the radial head fracture will also lead to proximal migration of the radius. Excision/ removal of the radial head should be avoided, as over time this will cause the rest of the radius to migrate proximally leading to wrist pain and loss of pronation and supination of the wrist. The radial head fracture is usually managed by open reduction internal fixation under general anaesthesia: the area is opened surgically, the surgeon forces the bones back into their correct positions, and then fixes them in place using titanium pins and/ or plates if the fracture is too comminuted (i.e., the bones have been crushed or fractured into many pieces) a radial head implant can be used. ![]() Plain radiography shows the radial head fracture, with dorsal subluxation of the ulna often seen on lateral view of the pronated wrist. The examination finding of tenderness of the distal radio-ulnar joint suggests an Essex-Lopresti injury in patients who have sustained high energy forearm trauma. ![]() The injury can be difficult to diagnose initially as medical attention is usually focused on the injury to the radial head, leading to the distal radio-ulnar injury being overlooked. This fracture typically occurs in patients who have fallen on an outstretched hand (a "FOOSH" injury). The injury is named after Peter Essex-Lopresti who described it in 1951. The Essex-Lopresti fracture is a fracture of the radial head of the forearm with concomitant dislocation of the distal radio-ulnar joint along with disruption of the thin interosseous membrane which holds them together. Open reduction and internal fixation with plates These fracture patterns include greenstick, torus, and spiral injuries, which are bending injuries rather than full-thickness cortical breaks.Ī greenstick fracture is a partial thickness fracture where only the cortex and periosteum are interrupted on one side of the bone while they remain uninterrupted on the other side.Ĭopyright © 2023, StatPearls Publishing LLC.Medical condition Essex-Lopresti fracture These and other qualities of the pediatric periosteum, as well as the increased compliance of the pediatric bone, are responsible for the unique fracture patterns seen in pediatric patients. Furthermore, the pediatric periosteum is more active, thicker, and stronger in children, which greatly decreases the chance of open fractures and fracture displacement. Due to their increased compliance, pediatric bones tend to have more bowing and bending injuries under stress that would cause a fracture in an adult bone. Therefore, prior to ossification, the majority of pediatric bone is just calcified cartilage, which is very compliant when compared to the ossified bones of adults. The calcified cartilage breaks down, allowing for vascular invasion and osteoblastic/osteoclastic bone matrix deposition and remodeling. The physis is split into 4 zones: (1) the reserve or resting zone, which is made up of hyaline cartilage (2) the zone of proliferation, which is made up of multiplying chondrocytes that arrange into lacunae (lakes) (3) the zone of hypertrophy, where the chondrocytes stop dividing and start enlarging and (4) the zone of calcification, where minerals are deposited into the lacunae to calcify the cartilage. However, long bones like the phalanges have only one physis. ![]() Long bones like the femur have 2 physes separated by a diaphysis, which is the shaft of a long bone. The physis is located towards the end of the long bone, with the epiphysis above it and the metaphysis below it. It allows for bone growth from a cartilage base, known as endochondral ossification, which differs from bone growth from mesenchymal tissue or intramembranous ossification. The physis is the growth plate in long bones, including phalanges, fibula, tibia, femur, radius, ulna, and humerus. The majority of differences between adult and pediatric skeletal systems are due to the open physis in the pediatric population, which allows for continued growth prior to skeletal maturation during puberty and adulthood. The makeup, anatomy, and histology of the pediatric skeletal system is not just a smaller version of the adult form rather, it is unique in that it allows for rapid growth and change throughout development from childhood to adulthood.
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