An anatomic and mechanical study of the interosseous membrane of the forearm: Pathomechanics of proximal migration of the radius

Hotchkiss, Robert N.; An, Kai Nan; Sowa, David T.; Basta, Steven; Weiland, Andrew J.

doi:10.1016/0363-5023(89)90017-8

Cited by 296 publications

(160 citation statements)

References 10 publications

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“…examined IOL strain in 6 preserved specimens [1][2][3] . They found strain to be greatest in neutral rotation.…”

Section: Discussionmentioning

confidence: 99%

“…The interosseous membrane of the forearm plays an important role in forearm stability and its main structural component is the strong ligamentous band of tissue in the central third of the forearm, described as the interosseous ligament (IOL) [1][2][3] . The fibers of the IOL run obliquely from a more proximal insertion on the radius to a more distal insertion on the ulna.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Passive strain distribution in the interosseous ligament of the forearm: implications for injury reconstruction

Gabriel¹,

Pfaeffle²,

Stabile³

et al. 2004

The Journal of Hand Surgery

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PURPOSE: For severe forearm injuries, such as an Essex-Lopresti lesion, functional reconstruction necessitates repair of the interosseous ligament (IOL) to restore normal load sharing between the raidus and ulna. Improperly locating or tensioning such a reconstuction can lead to abnormal load sharing and/or restriction of forearm rotation. The normal IOL strains should indicate the proper location of reconstruction grafts and the proper forearm rotation for tensioning the grafts. The objective of this study was to quantify the passive strain distribution the IOL of the forearm with passive rotation of the forearm throughout the range of motion. METHODS:The 3-D motions of the radius with respect to the ulna were measured throughout forearm rotation in ten cadaveric forearms using an instrumented spatial linkage.From the bone motions and ligament insertion site geometry from dissection and CT scanning, insertion site motions were determined and used to calculate changes in ligament fiber lengths. RESULTS:The measured strain distribution in the IOL was non-uniform and varied with forearm rotation. The overall magnitude of IOL strain was found to be greatest in supination and smallest in pronation. Also, in supination, the strains varied across fibers, with strains being greatest in the distal fibers and lowest in the proximal fibers. Strains in neutral rotation were uniform across fibers. While fibers were generally slack in pronation, proximal fibers were less slack than distal fibers.CONCLUSIONS: The results of this study indicate that fiber strains in the IOL vary from proximal to distal and depend on forearm rotation. Our data suggests that to prevent restriction of forearm rotation, all grafts should be tensioned in supination, where measured strains were generally highest. Our data also suggests that a two bundle IOL reconstruction may be necessary for proper load transfer between the radius and ulna in both supination and pronation.

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“…examined IOL strain in 6 preserved specimens [1][2][3] . They found strain to be greatest in neutral rotation.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Passive strain distribution in the interosseous ligament of the forearm: implications for injury reconstruction

Gabriel¹,

Pfaeffle²,

Stabile³

et al. 2004

The Journal of Hand Surgery

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“…It is generally accepted that, in addition to the TFCC, stability is achieved by various degrees of contribution from the extensor carpi ulnaris tendon (Garcia-Elias 1998), the pronator quadratus muscle (Johnson and Shrewsbury 1976) and the radioulnar interosseous membrane (Hotchkiss et al 1989).…”

Section: Functional Anatomy-ligaments Are Important Stabilizersmentioning

confidence: 99%

The radioulnar joint in distal radial fractures: A review

Lindau

Aspenberg

2002

Acta Orthopaedica Scandinavica

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-We searched The Cochrane Library andMedline regarding the radioulnar joint in distal radial fractures and found no randomized or controlled studies. This review presents the descriptive literature by summarizing accepted views and controversies. There is only weak support for the commonly accepted treatments. Current research has shown that distal radial fractures are often associated with ligament injuries not seen on radiographs. These injuries can lead to laxity of the DRU-joint and subsequent worse outcome, which indicates that we must have a complete diagnosis including ligament injuries if we want to understand better the fracture and its sequelae. Randomized studies should be done before advocating surgical treatment of these unforeseen injuries. n What's the problem?

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“…In order to gain a clearer understanding of the consequences of radial head resections (1,18,32,59,71,84) (elbow instability, radiocapitellar joint contact loss, proximal migration of the radius) in comminuted radial head fractures, research was carried out on human cadaver elbows in order to examine the function of the radial head (31,51,63,64,66) and the role of the anterior band of the medial collateral ligament (aMCL), the interosseous membrane (MI) and the triangular fibrocartilaginous complex (TFCC) (20,37,38,66,70,74,75).…”

Section: Biomechanicsmentioning

confidence: 99%

“…It can be concluded that the radial head as well as different ligamentous structures are extremely important for normal functioning of the elbow (17,22,29,37,38,51,61,62,63,66,89). (73,74).…”

Section: Biomechanicsmentioning

confidence: 99%

Current Concepts Review

Harcke¹,

Kumar²

1991

Journal of Pediatric Orthopaedics

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The treatment of simple radial head fractures type Mason-Hotchkiss 1 and 2 is unequivocal. In the case of a displacement of less than 2 mm (MasonHotchkiss 1), functional conservative treatment is indicated. If the displacement is more than 2 mm (Mason-Hotchkiss 2) internal fixation is indicated, combined with treatment of the soft-tissue injuries. The treatment of comminuted radial head fractures Mason-Hotchkiss type 3 is more controversial, as they are usually associated with ligament injuries. Conservative treatment appears to have unsatisfactory results. Opinions differ on surgical treatment, i.e. 1) excision of the radial head ; 2) reconstruction by means of internal fixation ; 3) excision and reconstruction with a prosthesis. Basic experimental research on human cadaver elbows shows the importance of the conservation of the radial head, especially in case of associated soft tissue injuries. In most cases a stable osteosynthesis is impossible, and in case of associated ligament disruptions, resection and reconstruction by means of a rigid radial head prosthesis should be considered. Experimental research demonstrates promising results for rigid radial head prostheses in human cadaver elbows with a resected radial head and failing medial collateral ligament. Short-term clinical studies seem to confirm this, but long-term results are as yet unknown.

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An anatomic and mechanical study of the interosseous membrane of the forearm: Pathomechanics of proximal migration of the radius

Cited by 296 publications

References 10 publications

Passive strain distribution in the interosseous ligament of the forearm: implications for injury reconstruction

Passive strain distribution in the interosseous ligament of the forearm: implications for injury reconstruction

The radioulnar joint in distal radial fractures: A review

Current Concepts Review

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