Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint

Abstract

ObjectivesTo measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ).MethodsFrom January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described.ResultsThe follow-up time was 20 months (6–36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1–6). DASH was 5.63/100 (1–18). The time to return to work was 7.37 months (3–12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well.ConclusionThe new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

Radius distraction could contribute to long-term stability for treating distal radioulnar joint instability during volar plating of distal radius fracture: a retrospective case series study

“…While successful surgical treatments to confer DRUJ stability were well-documented, most of these treatments comprised either prolong immobilization or intrinsic TFCC repair or extrinsic ligament reconstruction following internal xation of DRF (13)(14)(15)(16)(17)(18)(19), which may result in joint stiffness and delayed functional recovery for prolong immobilization, and the steep learning curve of repair or reconstruction of soft-tissue stabilizers for the DRUJ may hinder the application of these treatments to the setting of acute injury.…”

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

“…In contrast, reconstruction of the richly innervated DOB with tendon grafts (Riggenbach et al ) may not address the sensory function of that IOM bundle (Kim et al ), and consequently fails to account for the dynamic aspects of DRUJ stability. Alternatively, the DOB could be reconstructed with brachioradialis distal tendon rerouting (Aita et al ) or bone‐patella tendon‐bone interposition. A histological study has shown that the patellar tendon contains sensory nerve endings (Cabuk & Kusku‐Cabuk, ); however, the bone‐patellar tendon‐bone graft has been only performed for reconstruction of the CB (Marcotte & Osterman, ; Gaspar et al ).…”

Acute Essex-Lopresti Syndrome: About a Case of Brachioradialis Tendon Transfer

“…At the level of the wrist, a transfer of the brachioradialis was performed according to the technique described by Aita et al, 14 modified by us (►Fig. 2).…”

“…Middle: the Apergis technique with: transfer of the brachioradialis tendon detached from its distal insertion and re-attached to the ulna at the junction of middle and lower thirds using an interference screw; reinsertion of the triangular fibrocartilage complex (TFCC). Right: the modified technique by Aita et al14 with transfer of the brachioradialis tendon severed from its proximal muscular attach then reattached to the neck of the ulna and fixed by an anchor. The red geometric figure represents the bulk of the muscle body of the brachioradialis.…”