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

Masouros, Panagiotis; Apergis, Emmanuel; Mavrogenis, Andreas F.; Babis, George C.; Artemi, Dendi K.; Nikolaou, Vasileios S.

doi:10.1177/1753193419866382

Cited by 11 publications

(6 citation statements)

References 41 publications

(92 reference statements)

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“…Cadaveric studies have tested different allografts for IOM reconstruction. 25 Pffaefle et al 21 used flexor carpis radialis (FCR) autograft and were able to restore resistance to axial loads with success, but tendon grafts lengthen over time because of plastic deformation of the tendon. Smith et al 26 reported one patient treated with flexor digitorum superficialis autograft with satisfactory results at four years’ follow-up.…”

Section: Discussionmentioning

confidence: 99%

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

Gallego,

Rotman,

Watts

2024

Bone Joint J

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AimsAcute and chronic injuries of the interosseus membrane can result in longitudinal instability of the forearm. Reconstruction of the central band of the interosseus membrane can help to restore biomechanical stability. Different methods have been used to reconstruct the central band, including tendon grafts, bone-ligament-bone grafts, and synthetic grafts. This Idea, Development, Exploration, Assessment, and Long-term (IDEAL) phase 1 study aims to review the clinical results of reconstruction using a synthetic braided cross-linked graft secured at either end with an Endobutton to restore the force balance between the bones of the forearm.MethodsAn independent retrospective review was conducted of a consecutive series of 21 patients with longitudinal instability injuries treated with anatomical central band reconstruction between February 2011 and July 2019. Patients with less than 12 months’ follow-up or who were treated acutely were excluded, leaving 18 patients in total. Preoperative clinical and radiological assessments were compared with prospectively gathered data using range of motion and the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) functional outcome score.ResultsOf the 18 patients (nine male, nine female) who met the inclusion criteria, the median follow-up was 8.5 years (interquartile range (IQR) 5.6 to 10). Their mean age was 49 years (SD 11). The mean extension improved significantly from 38° (SD 15°) to 24° (SD 9°) (p = 0.027), with a mean flexion-extension arc change from 81° (SD 27°) to 93° (SD 30°) (p = 0.172) but with no forearm rotational improvement (p = 0.233) at latest follow-up. The QuickDASH functional score improved significantly from 80 (SD 14) to 52 (SD 26) following reconstruction (p = 0.031), but generally the level of disability remains high. Radiological assessment showed no progression of proximal migration of the radius, with a stable interbutton distance and ulnar variance from immediate postoperative radiograph to the latest follow-up.ConclusionCentral band interosseus membrane reconstruction using a synthetic braided cross-linked graft can improve patient-rated arm function and range of motion, but significant functional deficits remain in patients with chronic injuries.Cite this article: Bone Joint J 2024;106-B(2):182–188.

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Section: Discussionmentioning

confidence: 99%

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

Gallego,

Rotman,

Watts

2024

Bone Joint J

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“…As we all know, the overall stability of the forearm depends on the integrity of radioulnar articulations, encompassing the proximal radioulnar joint (PRUJ) and the distal radioulnar joint (DRUJ). These constructs are connected by the tough inelastic fibrous interosseous membrane (IOM) complex ( 26 ). IOM consists of five distinct components: the central band (CB); the accessory band (AB); the distal oblique bundle (DOB); the proximal oblique cord (POC), and the dorsal oblique cord ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Ulnar osteotomy between the proximal 1/3 and 1/5 provides a stable radiocapitellar joint in chronic Monteggia fracture

Fu,

He,

Wang

2024

Transl Pediatr

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Background The precise location of unlar osteotomy remains a subject of ongoing controversy in chronic Monteggia fracture (CMF). The purpose of this study was to analyze the influence of different levels of ulnar osteotomy on redislocation in CMF. Methods We retrospectively reviewed 18 children following our previous series. Except the baseline characteristics and radiographic parameters such as ulnar osteotomy angle, maximum interosseous distance (MID) and proportional ulnar length (PUL), we introduced a new parameter: proportional ulnar osteotomy (PUO) which represents the quantitative level of proximal ulnar osteotomy. Based on the value of PUO, we divided it into two intervals: appropriate PUO range (1/5< PUO <1/3) and inappropriate PUO range (PUO >1/3; PUO <1/5). The relationship between these indexes and redislocation was analyzed. Results According to the reduction state of radial head, patients were divided in two groups: reduced (15/18) and redislocation (3/18). Only PUO range differed significantly (P=0.043) between the two groups, with a notably higher number of patients showed an osteotomy between 1/5 and 1/3 of ulna in reduced group. Combining PUO range with radiographic parameters (osteotomy angle and post-PUL) improved the accuracy and specificity over using osteotomy angle and post-PUL (accuracy, 94.44% vs. 83.33%) (specificity, 93.33% vs. 86.67%, P=0.008). This combination further enhanced the predictive capability for detecting the risk of redislocation in CMFs. Conclusions Ulnar osteotomy between the proximal 1/3 and 1/5 appears to provide a much safer and more stable radiocapitellar joint in CMF.

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“…By far, reconstruction of the forearm interosseous membrane was a controversial topic. Some authors suggested enhancing the stability of the proximal radioulnar joint [37]. However, we considered that the tremendous clinical outcome could be achieved with a complete repair of the proximal radioulnar ligament and early rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

The diagnosis and treatment in patients with a bipolar fracture–dislocation of the forearm: a retrospective study

et al. 2022

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Backgrounds This study aims to investigate the treatment and clinical effect of bipolar fracture–dislocation of the forearm. Methods From March 2011 to September 2021, patients with bipolar fracture–dislocation of the forearm admitted to XXX and XXX Hospital were retrospectively analyzed. The timing of rehabilitation depended on the joint stability after the operation. The forearm function was evaluated according to the Anderson forearm function score. Results A total of 40 patients who underwent surgical treatment were screened, but only 24 received a minimum of 6 months of follow-ups and were included in the study. Nineteen males and five females were enrolled in the study, with an age range of 18–65 years and an average of 40.4 years. With an average follow-up of 23.6 months (7–62 months), no case was related to functional malformations and infections. The average range of motion of flexion and extension at the elbow was 125.9° (98°–138°), the average range of motion of flexion and extension at the wrist was 144.2° (120°–156°), and the average range of motion of rotation at the forearm was 139.6° (88°–170°). The Anderson's forearm function score of the last follow-up presented: excellent in 16 cases, satisfactory in 6 cases, dissatisfactory in 1 and failure in 1. Conclusions Bipolar fracture–dislocation of the forearm always represents high-energy injuries, of which the treatment principle includes complete reduction in distal and proximal dislocations and rehabilitation training as early as possible. Intraoperative fracture fixation follows after a stable reduction in the dislocation.

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

Cited by 11 publications

References 41 publications

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

Central band interosseus membrane reconstruction for longitudinal instability injuries of the forearm

Ulnar osteotomy between the proximal 1/3 and 1/5 provides a stable radiocapitellar joint in chronic Monteggia fracture

The diagnosis and treatment in patients with a bipolar fracture–dislocation of the forearm: a retrospective study

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