Digitalization of the IOM: A comprehensive cadaveric study for obtaining three-dimensional models and morphological properties of the forearm\u2019s interosseous membrane

Fabio Carrillo,Jess G Snedeker,Fabio A Casari,Ladislav Nagy,Reto Sutter,Philipp Fürnstahl,Simon Suter

doi:10.1038/s41598-020-63436-3

Fabio Carrillo, Jess G Snedeker + Show 5 more

Open Access

https://doi.org/10.1038/s41598-020-63436-3

Copy DOI

Abstract

State-of-the-art of preoperative planning for forearm orthopaedic surgeries is currently limited to simple bone procedures. The increasing interest of clinicians for more comprehensive analysis of complex pathologies often requires dynamic models, able to include the soft tissue influence into the preoperative process. Previous studies have shown that the interosseous membrane (IOM) influences forearm motion and stability, but due to the lack of morphological and biomechanical data, existing simulation models of the IOM are either too simple or clinically unreliable. This work aims to address this problematic by generating 3D morphological and tensile properties of the individual IOM structures. First, micro- and standard-CT acquisitions were performed on five fresh-frozen annotated cadaveric forearms for the generation of 3D models of the radius, ulna and each of the individual ligaments of the IOM. Afterwards, novel 3D methods were developed for the measurement of common morphological features, which were validated against established optical ex-vivo measurements. Finally, we investigated the individual tensile properties of each IOM ligament. The generated 3D morphological features can provide the basis for the future development of functional planning simulation of the forearm.

Highlights

The musculoskeletal structure of the human forearm enables functions required for the activities of daily living, i.e., pro-/ supination motion, while the surrounding ligament and tendon structures provide stability and allow the translation of forces across the forearm
The kinematics of the pro-supination and the range of motion (ROM) reached by the patient is strongly influenced by the interosseous membrane (IOM), the biggest ligamentous complex in the forearm that connects the radius and ulna bones in the diaphysis[15,16,17,18,19,20,21,22]
Few studies have previously reported the need for a partial release of the IOM in some cases of forearm osteotomy, because the tension exerted by a posttraumatic contracture of the IOM prevented the completion of the planned bone correction[27,28,29]

Summary

Introduction

The musculoskeletal structure of the human forearm enables functions required for the activities of daily living, i.e., pro-/ supination motion, while the surrounding ligament and tendon structures provide stability and allow the translation of forces across the forearm. From our empirical clinical experience, we have observed a similar behaviour, in which forearm rotation remained restricted after precise restoration of the geometry of the forearm bones These findings make clear the need for forearm simulation models capable of including the influence of the soft tissue in order to improve the accuracy of the surgical outcomes[5,6]. In order to generate a simulation capable of considering the individual contributions of the IOM structures on the forearm motion, their corresponding tensile properties are needed. Thereby, the objective of this study was the generation of 3D morphological parameters and individual tensile properties for each IOM structure of the forearm, namely, the distal oblique bundle, the distal accessory band, the central band and the dorsal oblique accessory cord, based on cadaveric ground-truth data. This work aims to generate ground-truth data for the validation of currently under-development forearm motion models and to provide the basis for the future development of dynamic forearm surgical planning

Objectives

Methods

Results

Conclusion