Interosseous Membrane Of Forearm Research Articles

Morphological changes in the interosseous membrane of the forearm during forearm rotation.

[Purpose] Changes in forearm interosseous membrane dynamics during forearm rotation relative to the shoulder joint position remain poorly understood. The purpose of this study was to clarify interosseous membrane dynamics during forearm rotation in shoulder abduction and external rotation positions. [Participants and Methods] We conducted open magnetic resonance imaging on 17 healthy forearms in the prone position. Three limb positions were set for measuring the forearm rotation angle: intermediate, maximum pronation, and maximum supination. Images were obtained with the shoulder joint abducted at 90°and externally rotated at 90°. The forearm interosseous membrane angle was measured at three points: the apex of the forearm interosseous membrane, the radius, and the ulna. The measurement of the interosseous angle was repeated thrice. [Results] Sufficient intra-rater reliability was confirmed for the forearm interosseous membrane angle measurement. The interosseous membrane of the forearm showed a mean dorsal convex shape during forearm pronation (141.7° ± 0.83°), and the mean palmar convex shape during forearm supination (-141.6° ± 0.64°). [Conclusion] This study provides useful information for future research by quantifying the dynamics of the interosseous membrane of the forearm, which is an important soft tissue for forearm rotation. The establishment of a quantitative evaluation method for forearm interosseous morphological changes will help further elucidate forearm rotation movements during sports activities.

Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation

The purpose of this study was to measure distal radioulnar joint (DRUJ) dislocation and radioulnar displacement associated with sequential sectioning of the different bands of the interosseous membrane and triangular fibrocartilage complex in the simulation of a Galeazzi fracture dislocation. Twelve fresh-frozen cadaver forearms were dissected. We examined the anatomy and function of the forearm interosseous membrane. Each forearm was then mounted onto a biomechanical wrist and forearm device. In the control group, radial osteotomy was performed and the degree of DRUJ displacement with progressive loads was measured. In addition to radial osteotomy, in group 1, the central band (CB) was sectioned; in group 2, the CB, distal membranous portion of the interosseous membrane, and distal oblique bundle were sectioned; and in group 3, the CB, distal membranous portion of the interosseous membrane, distal oblique bundle, and triangular fibrocartilage complex were sectioned. The radioulnar displacement (mm) at 25 N, 50 N, and 75 N was recorded. In group 1, applying progressive loads resulted in an average DRUJ displacement of 4.3, 5.9, and 7.9 mm, respectively. In group 2, the displacement was 5.2, 5.7, and 6.9 mm, respectively. In group 3, the displacement was 6.2, 8.1, and 9.9 mm, respectively. Our study showed a correlation between increase in the load applied to the same injury and the degree of displacement (P= .001). In group 3, the degree of DRUJ displacement was statistically increased compared to the other groups (P= .04). Migration of the radius under loads implies disruption of both the CB and triangular fibrocartilage complex. The distal oblique bundle by itself does not seem to have a relevant role in radioulnar displacement at the DRUJ. This study provides insights into the interosseous membrane and stability of the DRUJ, which can contribute to a better understanding of Galeazzi fracture-dislocations.

Biomechanical assessment of the central band of the interosseous membrane using shear wave elastography: reliability and reproducibility.

The interosseous membrane of the forearm is an essential structure for the stability of the forearm skeleton, the most important part being the central band. The purpose of this study was to determine if shear wave elastography, a non-invasive ultrasound technique, can be used to measure shear wave speed in the central band and quantify stiffness. Fifteen healthy adult subjects were included (30 forearms). The participants forearms were positioned on an articulated plate, with their hand in neutral, pronated and then supinated positions of 30°, 60° and 90°. The shear wave speed was highest in 90° pronation (4.4 m/s (SD 0.3)) and 90° supination (4.4 m/s (SD 0.27)) indicating maximum stiffness in these positions. Its minimum value was in the neutral position, and either in 30° pronation or supination (3.5 m/s (SD 0.3)). Intra- and interobserver agreement was excellent, regardless of probe positioning or forearm mobilization. This study presents a reliable shear wave elastography measurement protocol to describe the physiological function of the central band of the interosseous membrane in healthy adults.Level of evidence: IV.

Does the inter-osseous membrane fascial dysfunction exist ? An observational study comparing palpation to ultrasound measurements

BackgroundThere is a lack of evidence to support a correspondence between osteopathic palpation and anatomical findings. The concept of dysfunction could be defined using more accurate words when describing palpatory findings if they could be explained by objective measurements. The forearm Interosseous Membrane (IOM) is a fascia often evaluated by osteopaths, searching for Fascial Dysfunction (FD). We measured IOM physical characteristics, such as elasticity and thickness, with ultrasound (US) and then compared it with osteopaths’ FD assessment. MethodsHealthy subjects were recruited and their forearms were marked every centimeter. At every mark, 3 registered osteopaths assessed the potential FD (none, moderate or strong). Assessments were compared to the IOM elasticity and thickness measured by US. A mixed effect model was used to analyse the link between thickness and FD and a chi-2 test for the link between elasticity and FD. Result41 subjects were included. Mean age was 28.1, 46% were men. The average IOM length was 13.0 cm (±1.5), the average thickness was 1.29 (±0.41). The mixed model found a strong correlation between the grade of FD and the IOM thickness for all three osteopaths (p < 0.01). Moreover, correlations were found between thickness and elasticity of the IOM (p < 0.001). ConclusionManual evaluation of FD seems to be correlated to physical properties of the IOM. Our results suggest that the forearm IOM is thicker at FD locations. This study needs replications on several anatomical areas and on the IOM of symptomatic subjects to confirm these findings. Moreover, research could focus on tissue changes after osteopathic treatment.

Automatic modelling of human musculoskeletal ligaments - Framework overview and model quality evaluation.

Accurate segmentation of connective soft tissues in medical images is very challenging, hampering the generation of geometric models for bio-mechanical computations. Alternatively, one could predict ligament insertion sites and then approximate the shapes, based on anatomical knowledge and morphological studies. In this work, we describe an integrated framework for automatic modelling of human musculoskeletal ligaments. We combine statistical shape modelling with geometric algorithms to automatically identify insertion sites, based on which geometric surface/volume meshes are created. As clinical use case, the framework has been applied to generate models of the forearm interosseous membrane. Ligament insertion sites in the statistical model were defined according to anatomical predictions following a published approach. For evaluation we compared the generated sites, as well as the ligament shapes, to data obtained from a cadaveric study, involving five forearms with 15 ligaments. Our framework permitted the creation of models approximating ligaments' shapes with good fidelity. However, we found that the statistical model trained with the state-of-the-art prediction of the insertion sites was not always reliable. Average mean square errors as well as Hausdorff distances of the meshes could increase by an order of magnitude, as compared to employing known insertion locations of the cadaveric study. Using those, an average mean square error of 0.59mm and an average Hausdorff distance of less than 7mm resulted, for all ligaments. The presented approach for automatic generation of ligament shapes from insertion points appears to be feasible but the detection of the insertion sites with a SSM is too inaccurate, thus making a patient-specific approach necessary.

Forearm Interosseous Membrane Maintains the Stability of Proximal Radioulnar Joint.

ObjectiveTo evaluate the effect of the proximal and central bundles of the interosseous membrane on the stability of proximal radioulnar joint.MethodsTwenty fresh samples of human forearm provided by the anatomy room of the Department of Human Anatomy of Nanjing Medical University were included in this study. They were used to explore the effect of proximal interosseous membrane bundle on the stability of proximal radioulnar joint. The proximal bundle was reconstructed along the original attachment point. The reconstructions of central bundle were divided into the reconstruction of original attachment point on radius‐midpoint of the ulnar original attachment point (reconstruction A) and original attachment point reconstruction (reconstruction B). The loads of the proximal radioulnar joint in different positions were measured. The load of the proximal radioulnar joint was analyzed in neutral, pronation, and supination positions.ResultsAfter resection of proximal and central fascicles, the loads of proximal radioulnar joint in neutral, pronation, and supination positions were significantly lower than those before resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05), and that after reconstruction B in pronation position was higher than that after resection (P < 0.05), while there was no significant difference between reconstruction A and after resection (P > 0.05). In supination position, the load of reconstruction B was higher than that of reconstruction A (P < 0.05). After reconstruction of the proximal and central bundles, the proximal radioulnar joint could not reached the same load as it could before resection (P < 0.05).ConclusionThe stability of proximal radioulnar joint is affected by central bundle and proximal bundle. Reconstruction can increase the stability of proximal radioulnar joint.

Ligamentous Reconstruction of the Interosseous Membrane of the Forearm in the Treatment of Instability of the Distal Radioulnar Joint.

Ligamentous Reconstruction of the Interosseous Membrane of the Forearm in the Treatment of Instability of the Distal Radioulnar Joint.

Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm.

The human interosseous membrane (IOM) is a fundamental stabilizer during forearm rotation. To investigate the dynamic aspects of forearm stability, we analyzed sensory nerve endings in the IOM. The distal oblique bundle (DOB), the distal accessory band (DAB), the central band (CB), the proximal accessory band (PAB), the dorsal oblique accessory cord (DOAC) and the proximal oblique cord (POC) were dissected from 11 human cadaver forearms. Sensory nerve endings were analyzed at two levels per specimen as total cell amount/mm2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4',6-diamidino-2-phenylindole on an Apotome microscope, according to Freeman and Wyke's classification. Sensory nerve endings were significantly more commonly found to be equally distributed throughout the structures, rather than being epifascicular, interstitial, or close to the insertion into bone (P≤0.001, respectively). Free nerve endings were the predominant mechanoreceptor in all six structures, with highest density in the DOB, followed by the POC (P≤0.0001, respectively). The DOB had the highest density of Pacini corpuscles. The DOAC and CB had the lowest amounts of sensory innervation. The high density of sensory corpuscles in the DOB, PAB and POC indicate that proprioceptive control of the compressive and directional muscular forces acting on the distal and proximal radioulnar joints is monitored by the DOB, PAB and POC, respectively, due to their closed proximity to both joints, whereas the central parts of the IOM act as structures of passive restraint.

Reconstruction of the forearm interosseous membrane: a biomechanical study of three different techniques.

Reconstruction of the interosseous membrane has the potential to re-establish a normal loading pattern through the forearm and enhance stability after an Essex-Lopresti lesion. The aim of our study was to assess the capacity of three different techniques, which all use a regionally harvested autograft, to restore longitudinal stability. Simulation of the Essex-Lopresti lesion was done by excising the radial head and sectioning the interosseous membrane in seven cadaveric specimens. Each technique was used in each specimen consecutively, using the pronator teres, the brachioradialis and the flexor carpi radialis tendons, respectively. The specimens were submitted to mechanical testing by applying proximally migratory forces to the radius and radioulnar displacement was assessed fluroscopically at wrist level. The pronator teres tendon achieved the greatest reduction (94% correction with respect to the intact interosseous membrane/radial head out state, followed by brachioradialis (92%) and flexor carpi radialis (85%). However, no statistically significant differences in displacement data or strength were detected between the techniques.

Anatomical study on the attachment location of forearm interosseous membrane ligament

Objective To elucidate the composition and precise attachment location of the forearm interosseous membrane ligament complex. Methods Thirty-two adult cadaveric forearm specimens were dissected to identify all ligaments of the interosseous membrane, measure the distance between the attachment site and the radius styloid process or the tip of the ulna head, and express the attachment location of the ligament by the percentage of the length to the length of the whole ulna and radius. Results The forearm interosseous membrane consists of five ligament components: central ligament, accessory ligament, distal oblique tract, proximal oblique cord and dorsal accessory oblique cord. The distal and proximal positions of the radius origin of the central ligament were 55% and 66% of the total radius length, respectively, and 30% and 42% of the total ulna length. The central points of the radius and ulna attachment location were 38% of the radius and 24% of the ulna for the accessory ligament, 10% of the radius and 16% of the ulna for the distal oblique tract, 78% of the radius and 82% of the ulna for the proximal oblique cord, and 63% of the radius and 65% of the ulna for the dorsal accessory oblique cord. Conclusion This study elucidates the precise attachment location of all the typical forearm interosseous membrane ligaments. This information is very useful for the biomechanical study of the interosseous membrane ligaments and the appropriate transplantation location of the interosseous membrane reconstruction surgery. Key words: Forearm; Anatomy; Interosseous membrane; Ligaments; Attachment location

Anatomic Characteristics of the Distal Oblique Bundle of the Interosseous Membrane of the Forearm.

The distal oblique bundle of the forearm is a structure that has been under vigorous investigation for the past decade. It is part of the distal interosseous membrane (DIOM) and seems to have an important stabilizing effect in the distal radioulnar joint. In this essay, we have tried to summarize the anatomical characteristics of the structure. We have also compared and contrasted this to our own experience with eight freshly frozen forearms. It is our strong belief that the distal oblique bundle (DOB) may play a keystone role in future stabilization techniques of the distal radioulnar joint, and its anatomy characteristics need to be fully investigated.

Late Reconstruction of the Interosseous Membrane with Bone-Patellar Tendon-Bone Graft for Chronic Essex-Lopresti Injuries: Outcomes with a Mean Follow-up of Over 10 Years.

The purpose of this study was to report our long-term outcomes following reconstruction of the forearm interosseous membrane (IOM) with bone-patellar tendon-bone (BPTB) graft for treatment of chronic Essex-Lopresti injuries. We identified 33 patients who underwent IOM reconstruction with BPTB graft for chronic Essex-Lopresti injuries over a 20-year treatment interval. Twenty male and 13 female patients, with a mean age of 42.1 years (range, 19 to 73 years) and a minimum follow-up interval of 5 years, were included. Preinjury clinical examination and radiographic measurements were obtained from records for comparison with prospectively collected data. Additional functional outcome data collected postoperatively included QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]), modified Mayo wrist (MMW), and Broberg-Morrey elbow function scores. IOM reconstruction was performed at a mean interval (and standard deviation) of 44.9 ± 60.0 months (range, 6.4 to 208 months) from the time of the initial injury. At a mean follow-up of 10.9 ± 4.4 years (range, 5.5 to 24.2 years), significant improvements were observed in mean elbow flexion-extension arc (+13° [95% confidence interval (CI), 4° to 22°]; p = 0.005), wrist flexion-extension arc (+19° [95% CI, 4° to 34°]; p = 0.016), forearm pronation-supination (+23° [95% CI, 8° to 39°]; p = 0.004), and grip strength (+25% of that of the contralateral side [95% CI, 18% to 32% of contralateral side]; p < 0.001). Improvements in ulnar variance were sustained over the long term from +3.9 mm (95% CI, 3.2 to 4.6 mm) preoperatively to -1.6 mm (95% CI, -2.3 to -0.9 mm) immediately postoperatively and -1.1 mm (95% CI, -1.8 to -0.4 mm) at the time of the final follow-up (p < 0.001). The mean QuickDASH, MMW, and Broberg-Morrey scores were 29.8 (range, 5 to 61), 82.7 (range, 60 to 100), and 91.6 (range, 64 to 100), respectively. IOM reconstruction with a BPTB graft is an effective treatment option for chronic Essex-Lopresti injuries, with satisfactory clinical and functional outcomes over the long term. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Characteristics and treatments of the Essex-Lopresti injury

To summarize experiences of operative treatment for Essex-Lopresti injury, and analyze the effect of the compare repair of interosseous membrane of forearm(IOM)on the forearm function. Twenty-four patients of Essex-Lopresti injury were treated from January 2005 to December 2013, 16 patients(group A) with radius and/or ulna fractures were treated with open reduction and internal fixation of radius or ulna and repair of forearm bone membrane at the same time, and then treated with open reduction and internal fixation of head of radius, as well as lower ulnar joint fixation or repair of wrist triangle fiber complex. Another 8 patients without radius and or ulna fractures(group B) were treated with open reduction and internal fixation of head of radius, as well as lower ulnar joint fixation or repair of wrist triangle fiber complex. The wrist joint function was evaluated using Cooney wrist functional rating index, and the elbow joint function was evaluated using Mayo elbow-performance score 2 weeks and 2 years after operation. According to Cooney wrist functional rating index, 4 patients in group A got a fair result and 12 poor, 2 patients in group B got a fair result and 6 poor 2 weeks after operation; 8 patients in group A got a good result, 6 fair and 2 poor, 5 patients in group B got a good result, 2 fair and 1 poor 2 years after operation. According to Mayo elbow-performance score, 2 patients in group A got a good result, fair and 6 poor, 1 patient in group B got a good result, 5 fair and 2 poor 2 weeks after operation; 8 patients in group A got a good result, 6 fair and 2 poor, 4 patients in group B got a good result, 3 fair and 1 poor. There were no statistically differences between two groups 2 weeks and 2 years after operation. It is important to restore the length of radius and/or ulna and maintain the dynamic stabilization of elbow and wrist for treat Essex-Lopresti injury. The repair of IOM has no effect on the forearm function.

Longitudinal instability of the forearm.

The Essex Lopresti lesion is arare triad of injury to the radial head, interosseous membrane of the forearm and distal radio-ulnar joint, which results in longitudinal instability of the radius. If unrecognized this leads to chronic pain and disability which is difficult to salvage. Early recognition and appropriate treatment is therefore desirable to prevent long-term problems. The aim of this article is to review the pathoanatomy of longitudinal radius instability and use the existing literature and authors' experience to provide recommendations for recognition and treatment of acute and chronic forearm instability, including description of the author's technique for interosseous membrane reconstruction.

The Development of the Interosseous Membrane of the Forearm

Aim: The purpose of this research is to study the forearm interosseous membrane (IOM) in embryos and fetal specimens, in order to determine its tissular origin, stage of appearance, and whether there is an early prenatal existence of the fibers and bundles present in adults, such as the central band, the accessory ascendant bundle, and the distal oblique bundle. Materials and Methods: A population of 10 embryos from 7 to 12 weeks (group 1) and 22 fetuses from 12 to 22 weeks (group 2) was studied. Specimens in group 1 were studied by axial sections and histological staining techniques: hematoxylin-eosin, Mallory trichrome stain, and silver stain. The week of appearance of the IOM, as well as the tissue that gave rise to it, was recorded. Specimens in group 2 were studied by anatomical dissections under 6× to 12× magnification and the IOMs were observed by direct and backlighting. The presence of the central band and the oblique ascendant bundle was studied at the proximal membrane. At the distal IOM (distal to the upper limit of the pronator quadratus), the presence of the distal oblique bundle was investigated. Results: We noticed that the IOM developed from the mesenchymal tissue located between the radius and ulna featuring a bridge between both bones at the chondrification stage. This mesenchyma was observed as an extension of the perichondrium of both bones. The mesenchymal bridge withdraws in order to conform to the IOM. We dated this process between the seventh and eighth week (50-56 days). In group 2, we observed the central band fibers. More proximal fibers were noticed earlier, while the distal most were observed in the last weeks. As far as the ascendant oblique bundle, it was seen in the entire group at the posterior surface of the IOM featuring an arrangement similar to the adult. At the distal IOM (distal to the upper pronator quadratus border), we were not able to identify a distal oblique bundle, as in the adult. The distal IOM was thin and displayed just a developing tissue without a distinct organization. Conclusion: The IOM arises from the mesenchymal tissue located between the ulnar and radial perichondrium. This tissue withdraws between the seventh and eighth week, forming the IOM. The gross anatomical features of the proximal fetal IOM are almost the same as in the adult. The central band fibers and the oblique ascendant band were observed. However, the fetal distal IOM did not showed a distal oblique bundle, well developed in most adults. These results might mean that the distal IOM arrangement in the adult is a consequence of the stress-strain forces to which it is subjected during the forearm and wrist movements, while the proximal membrane would follow a preestablished pattern.

Magnetic Resonance Imaging Evaluation of the Distal Oblique Bundle in the Distal Interosseous Membrane of the Forearm

Purpose: We aimed to determine whether the presence of the distal oblique bundle (DOB) can be evaluated in magnetic resonance imaging (MRI) examinations. Methods: We retrospectively reviewed 468 wrist and forearm MRIs taken in patients without acute fractures, infections, or tumors, and selected 80 MRIs that provided adequate coverage of the distal interosseous membrane (DIOM). We measured the thickness of the DIOM in the T2- weighted transverse plane. We used a picture archiving and communicating system and a model-based clustering method to determine whether some individuals have thicker DIOMs that can be considered as the DOB. Results: The thickness of the DIOM demonstrated a bimodal distribution, indicating the presence of patients with a thick DIOM (DOB). The model-based clustering method indicated that the optimal cutoff point was 1.0 mm. Twenty-six individuals (32.5%) had thick DIOMs with a mean thickness of 1.4 mm (SD, 0.2 mm), whereas 54 individuals (67.5%) had thin DIOMs with a mean thickness of 0.6 mm (SD, 0.2 mm). Conclusions: This study demonstrates that MRI can identify the presence of the DOB. The incidence and thickness of the DOB in this study support the findings of previous cadaveric studies on its morphology.

A biomechanical study on reconstruction of forearm interosseous membrane using extensor carpi radialis longus combined with radial head replacement for restoring forearm longitudinal stability

To evaluate the effect of reconstruction of forearm interosseous membrane (IOM) using extensor carpi radialis longus combined with radial head replacement for restoring the forearm longitudinal stability. Ten fresh-frozen adult cadaveric forearms were selected, including 8 males and 2 females with a mean age of 38.2 years (range, 29-74 years). Each forearm was treated as following steps: radial head excision (group A), radial head excision+the distal ulnar radial joints separation (group B), radial head excision+the distal ulnar radial joints separation+IOM central band excision (group C), reconstructed IOM with extensor carpi radialis longus tendon (group D), radial head prothesis replacement (group E), and reconstructed IOM with extensor carpi radialis longus tendon+radial head prothesis replacement (group F). The distance between ulna and radius and radioulnar joint displacement were observed under load and non load. The force loading on both ends of specimen was recorded when the radius shifted 5 mm proximally. Restoring the radial length could maintain normal distance between radius and ulna. The interosseous membrance reconstruction could restore the load transmission between radius and ulna. The force loading specimen was (74.507±4.967), (49.227±1.940), (17.827±1.496), (24.561±1.390), (140.247±8.029), and (158.423±9.142）N in groups A, B, C, D, E, and F respectively when the radius shifted 5 mm proximally, showing significant difference among groups (P<0.01). Reconstruction of the IOM with the extensor carpi radialis longus tendon is insufficient to restore the forearm longitudinal stability. Reconstruction using extensor carpi radialis longus tendon combined with radial head replacement may be a new choice for treatment of forearm longitudinal instability.

Management of the Essex-Lopresti Injury.

Essex-Lopresti injuries (ELIs) are characterized by fracture of the radial head, disruption of the forearm interosseous membrane, and dislocation of the distal radioulnar joint. This injury pattern results in axial and longitudinal instability of the forearm. Initial radiographs may fail to reveal the full extent of the injury, and therefore diagnosis in the acute setting requires a high index of suspicion. Early recognition and treatment are preferred as failure to fully treat the problem may result in chronic wrist pain from ulnar abutment or chronic elbow pain from radiocapitellar arthrosis. In this article the presentation, relevant anatomy, and management options for ELIs are overviewed, and a summary of outcomes reported in the literature is provided. Additionally, the preferred surgical technique of the senior author is presented, which involves reconstruction of the interosseous membrane with a local pronator rerouting autograft.

Interosseous Membrane of the Forearm.

Injuries of the interosseous membrane (IOM) of the forearm are frequently unrecognized, difficult to treat, and can result in a devastating sequelae for the wrist and elbow. The purpose of this review article is to evaluate the dignosis, biomechanics, clinical results, and propose a treatment approach to this rare complex entity. The biomechanical and clinical literature is reviewed. A treatment approach is described based on the known biomechanics and clinical experience of the senior author (T. W. W.). Multiple different reconstructive methods have been proposed for the treatment of both acute and chronic IOM injuries. The results of the published series are reviewed. IOM injuries can have reasonable outcomes particularly if diagnosed and treated early. There are multiple methods for treating patients with IOM injuries. Physicians should be highly suspicious about this injury when a patient presents with a highly displaced radial head fracture associated with wrist pain. Treatment with reconstruction of the cerebral band of the IOM with radial head replacement (do not overstuff) and temporary uploading the construct with K-wires from the ulna to the radius will give the most predictable results.

A biomechanical study of the reconstruction of the forearm interosseous membrane with the graft substitute

Objective To study the abilities of 3 graft tissues to linit proximal radial displacement compared with the native interosseous membrane (IOM) of the forearm. Methods Twelve biomechanics models harvested from fresh-frozen cadaveric forearms were mounted on testing machine. The specimens were tested under 100 newtons of constant axial load with the elbow and wrist in neutral rotation. Proximal displacement of the radius relative to the capitellum was measured. With the radial head excised specimens were first tested with the IOM intact. The IOM was then sectioned and central band IOM reconstruction were performed on each specimen using the following tissues: palmaris longus tendon, flexor carpi radialis (FCR) tendon, and achilles tendon allograft. Ten loading cycles were performed with each test configuration. The increase in proximal displacement between the first and 10th loading cycles represented the elongation of the graft. Results Mean proximal radial displacements were (3.02±3.56) mm (intact IOM), (6.78±4.12) mm (palmaris longus tendon), (5.08±6.78) mm (FCR tendon), (4.13±4.73) mm (achilles tendon allograft), all means were significantly different from each other. Mean graft elongations were (0.31±2.12) mm (intact IOM), (1.82±3.26) mm (palmaris longus tendon), (1.72±4.37) mm (FCR tendon), (0.36±2.89) mm (achilles tendon allograft). All means were significantly different from each other with the exception of means for palmaris longus tendon vs. FCR tendon and achilles tendon allograft vs. intact IOM. Conclusion No graft reconstruction limited proximal radial displacement as effectively as the native IOM. Of the 3 graft tissues the achilles tendon allograft is the best choice if IOM reconstruction is considered for treatment of an Essex-Lopresti injury. Key words: Forearm interosseous membrane; Reconstruction; Graft substitute; Biomechanics