Abstract

Subtle Essex-Lopresti Lesion (ELL) is a rare slow onset longitudinal forearm instability that can presents with subnormal initial radiographs and can easily be missed for the inattentive eye. We reviewed the literature about the subtle ELL illustrated by the report of 2 cases with initially isolated radial neck fractures that turned out to be a subtle ELL pattern.
The subtle ELL defined by normal or subnormal initial plain radiographs is usually an association of a slight rupture of the 3 longitudinal stability elements of the forearm being a proximal radius fracture, an inter osseous membrane (IOM) rupture and a distal radio ulnar joint dislocation. These subtle alterations that are often missed worsen with time as do their prognosis making it an emergency to diagnose them and treat them as soon as possible.
If diagnosis can involve ultrasound and MRI, the most important key is the initial clinical examination and plain radiographs that has both to be repeated in a short period of time.
Among the treatment options, for the acute diagnosis, treatment is similar to usual ELL. As for the missed ones, the proximal radius being usually healed with little displacement can be treated with an ulnar osteotomy alone with good results or associated with IOM reconstruction.
Subtle ELL is a rare condition but heavy of consequences for the patients that must be known diagnosed and treated as early as possible by upper extremity surgeons even if there is not a consensual treatment which asks for more research about that subject.

Key words: Essex-Lopresti; Forearm; Longitudinal stability; Traumatology; reconstruction; inter osseous membrane; central band.