Contribution of the Interosseous Membrane to Distal Radioulnar Joint Constraint

Abstract

Although forearm injuries are accompanied frequently by rupture to the interosseous membrane (IOM) diagnosis of the extent of IOM injury is difficult. In this study we evaluated distal radioulnar joint (DRUJ) laxity caused by both partial and complete IOM disruption and compared these quantitative measurements with the common clinical manual evaluation of DRUJ laxity and dislocatability. Human cadaveric forearms (n = 8) were used in this study. Skin, muscles, and tendons were removed. The specimens were mounted on an experimental apparatus that allowed the radius to move freely about the fixed ulna. Tests were performed in neutral rotation, 60 degrees pronation, and 60 degrees supination. Under various conditions of IOM sectioning testing was performed by volary and dorsally translating the radius relative to the ulna in the coronal plane of the radius. Testing was performed both qualitatively as would be performed in the clinic and quantitatively with an instrumented probe. Our results show that dorsal dislocation of the radius relative to the ulna strongly suggests distal IOM rupture. Disengagement of the radius from the DRUJ indicated injury to the distal and middle IOM. The distal IOM constrained volar and dorsal laxity of the radius at the DRUJ in all forearm rotation positions. The midportion of the IOM constrained laxity except in the volar direction of the pronated forearm. The proximal IOM did not constrain the proximal radius except dorsally for the pronated forearm position. The IOM, in particular the distal IOM, plays an important role in constraining dorsal dislocation of the radius at the DRUJ.