1
|
Yamazaki T, Matsuura Y, Toguchi Y, Suzuki T, Ohtori S. Biomechanical characterization of the central fibrous region of the forearm interosseous Membrane: Implications for finite element modeling. J Biomech 2024; 172:112204. [PMID: 38950484 DOI: 10.1016/j.jbiomech.2024.112204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
The interosseous membrane (IOM) of the forearm plays a crucial role in facilitating forearm function and mechanical load transmission between the radius and ulna. Accurate characterization of its biomechanical properties is essential for developing realistic finite element models of the forearm. This study aimed to investigate the mechanical behavior and material properties of the central fibrous regions of the IOM using fresh frozen cadavers. Ten forearms from five cadavers were dissected, preserving the IOM and identifying the distal accessory band (DAB), central band (CB), and proximal accessory band (PAB). Bone-ligament-bone specimens were prepared and subjected to uniaxial tensile testing, with the loading direction aligned with the fiber orientation. Force-displacement curves were obtained and converted to force-strain and stress-strain curves using premeasured fiber lengths and cross-sectional areas. The results demonstrated distinct mechanical responses among the IOM regions, with the PAB exhibiting significantly lower force-strain behavior compared to the DAB and CB. The derived force-strain and stress-strain relationships provide valuable insights into the regional variations in stiffness and strength of the IOM, highlighting the importance of considering these differences when modeling the IOM in finite element analysis. In conclusion, this study establishes a foundation for the development of advanced finite element models of the forearm that accurately capture the biomechanical behavior of the IOM.
Collapse
Affiliation(s)
- Takahiro Yamazaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Yasunari Toguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Takane Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| |
Collapse
|
2
|
Al Meklef R, Kacza J, Kremer T, Rein S. Periarticular Proprioception: Analyzing the Three-Dimensional Structure of Corpuscular Mechanosensors in the Dorsal Part of the Scapholunate Ligament. Cells Tissues Organs 2024:1-13. [PMID: 38631298 DOI: 10.1159/000538169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 02/29/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Sensory nerve endings transmit mechanical stimuli into afferent neural signals and form the basis of proprioception, giving rise to the self-perception of dynamic stability of joints. We aimed to analyze the three-dimensional structure of periarticular corpuscular sensory nerve endings in a carpal ligament to enhance our understanding of their microstructure. METHODS Two dorsal parts of the scapholunate ligament were excised from two human cadaveric wrist specimens. Consecutive cryosections were stained with immunofluorescence markers protein S100B, neurotrophin receptor p75, protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole. Three-dimensional images of sensory nerve endings were obtained using confocal laser scanning microscopy, and subsequent analysis was performed using Imaris software. RESULTS Ruffini endings were characterized by a PGP 9.5-positive central axon, with a median diameter of 4.63 μm and a median of 25 cells. The p75-positive capsule had a range in thickness of 0.94 μm and 15.5 μm, consisting of single to three layers of lamellar cells. Ruffini endings were significantly smaller in volume than Pacini corpuscles or Golgi-like endings. The latter contained a median of three intracorpuscular structures. Ruffini endings and Golgi-like endings presented a similar structural composition of their capsule and subscapular space. The central axon of Pacini corpuscles was surrounded by S100-positive cells forming the inner core which was significantly smaller than the outer core, which was immunoreactive for p75 and PGP 9.5. CONCLUSION This study reports new data regarding the intricate outer and intracorpuscular three-dimensional morphology of periarticular sensory nerve endings, including the volume, number of cells, and structural composition. These results may form a basis to differ between normal and pathological morphological changes in periarticular sensory nerve endings in future studies.
Collapse
Affiliation(s)
- Rami Al Meklef
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
- Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Johannes Kacza
- BioImaging Core Facility, College of Veterinary Medicine, Saxon Incubator for Clinical Translation, Leipzig University, Leipzig, Germany
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany
- Martin-Luther-University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
3
|
Hagert E, Rein S. Wrist proprioception-An update on scientific insights and clinical implications in rehabilitation of the wrist. J Hand Ther 2024; 37:257-268. [PMID: 37866985 DOI: 10.1016/j.jht.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
The field of wrist proprioception, as it relates to rehabilitation and surgery, has gone through a period of intense growth in the past decade. From being primarily focused on the function of the joint and ligaments in patients with wrist trauma or after wrist surgery, the understanding is now that of a greater complexity in treating not just the wrist but the hand and arm as a whole. Proprioception is derived from the Latin words "proprius" - belonging to (oneself) and "-ception" to sense. In other words, how to sense ourselves. To have a complete sense of self, multiple sensory afferents originating from joints, ligaments, muscles, tendons, nerves, skin, vision, and hearing work together to orchestrate a balanced integration of sensorimotor functions, with the true goal to perceive and adapt to the physical world around us. In this update on wrist proprioception, we review current developments in the understanding of proprioception, with an implication for our everyday work as hand therapists and hand surgeons. Each contributing sense-joint, ligaments, muscles, skin, and brain-will be reviewed, and the clinical relevance will be discussed. An updated wrist rehabilitation protocol is proposed where the therapist is guided to rehabilitate a patient after wrist trauma and/or surgery in 4 stages: (1) basic hand and wrist rehabilitation with a focus on reducing edema, pain, and scar formation; (2) proprioception awareness to improve the sense of joint motion and position; (3) conscious neuromuscular rehabilitation where isometric exercises of muscles that are beneficial for a particular injury are promoted, whereas others that are potentially harmful are avoided; and (4) unconscious neuromuscular rehabilitation with training of the reflex and joint protective senses.
Collapse
Affiliation(s)
- Elisabet Hagert
- Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar; Karolinska Institutet, Department of Clinical Science and Education, Stockholm, Sweden.
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
4
|
Freedman M, Freedman BA, Miller JS, Bierwirth P, Nelson WR. Treating Erythromelalgia with Interosseous Membrane Stimulation: An Autonomic Basis for the Condition and Its Treatment. Med Acupunct 2024; 36:63-69. [PMID: 38659724 PMCID: PMC11036148 DOI: 10.1089/acu.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background Erythromelalgia, which has primary and secondary presentations, causes heat, pain, and redness in the skin. The condition seems to have an autonomic basis, with vasomotor dysfunction causing dilatation of some blood vessels and constriction of others. No consistently effective treatments have been reported. Anticonvulsant, antidepressant, antihistamine, anti-inflammatory, antihypertensive, analgesic, nutritional, and topical approaches have been tried as were lidocaine infusions, nerve blocks, and thoracic and lumbar sympathectomies. Interosseous membrane stimulation appears to affect the local autonomic milieu in the extremity being treated. This approach was used on a patient with erythromelalgia. Case A 36-year-old woman with erythromelalgia was treated with interosseous membrane stimulation. Eight treatments were given over a 1-year timeframe at 1-3-month intervals. Results This patient repeatedly experienced much relief from her burning paresthesias, swelling, diaphoresis, and ruddy discoloration of her extremities for 6-8 hours following each treatment. The intensity of her discomfort subsided gradually over time. Conclusions Interosseous membrane stimulation is a safe, simple, and effective treatment for erythromelalgia, which is notoriously refractory to treatment. This patient's response to treatment might have been a result of localized derangement of her autonomic nervous system. It is possible that manipulation of the autonomic milieu of an extremity is a significant factor in the mechanism of action of interosseous membrane stimulation.
Collapse
Affiliation(s)
| | | | - Jon S. Miller
- Greenville NC VA Health Care Center, Greenville, NC, USA
| | | | | |
Collapse
|
5
|
Esplugas M, Lluch A, Salva-Coll G, Fernandez-Noguera N, Puig de la Bellacasa I, Llusa-Perez M, Garcia-Elias M. Influence of forearm rotation on the kinetic stabilizing efficiency of the muscles that control the scapholunate joint. Clinical application in proprioceptive and neuromuscular rehabilitation programs. J Hand Ther 2024; 37:282-292. [PMID: 37852910 DOI: 10.1016/j.jht.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND This study focuses on the relationship between forearm muscles, carpal ligaments, and their impact on scapholunate joint stability across varying forearm rotations. This is crucial for optimizing pre and postoperative rehabilitation strategies for scapholunate joint dysfunction. PURPOSE Our study aims to understand the kinetic influence of forearm muscles on scapholunate joint instability. We emphasize the significance of forearm rotation to enhance treatment efficacy. STUDY DESIGN We conducted an experimental study to understand how forearm muscles contribute to the stability of the scapholunate joint during different degrees of forearm rotation and we focused on the joint effect of muscle groups rather than individual muscles for treatment protocols. RESULTS Our findings shed light on the conservative treatment of dynamic scapholunate instability and the postoperative rehabilitation of scapholunate ligament repair. We found that the effect of forearm muscles significantly contributes to preserve stability in the scapholunate joint across various forearm rotational positions. These insights have practical implications for hand therapists, offering innovative strategies to enhance clinical practice. CONCLUSIONS This research underscores the importance of considering forearm rotation when developing rehabilitation protocols for scapholunate joint instability and provides a valuable perspective in line with current rehabilitation principles.
Collapse
Affiliation(s)
- Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain.
| | - Alex Lluch
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain; Department of Hand and Upper Extremity Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Guillem Salva-Coll
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Spain; Ibacma Institute, Balearic Institute for Hand and Wrist Surgery, Palma de Mallorca, Spain
| | - Nuria Fernandez-Noguera
- Department of Hand and Upper Extremity Surgery, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | | | | | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Kaplan Hand Institute, Barcelona, Spain; IFSSH; Fernando Fonseca Foundation, Terrassa, Spain
| |
Collapse
|
6
|
Freedman M, Bierwirth P. Interosseous Membrane Stimulation: A Treatment for Painful Peripheral Neuropathy. Med Acupunct 2023; 35:73-75. [PMID: 37095784 PMCID: PMC10122244 DOI: 10.1089/acu.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Painful peripheral neuropathy is a condition that may be associated with diabetes as well as other causes of neuropathy. Common treatments for the pain include topical application of capsaicin as well as using oral medications, typically gabapentin. The results are variable and rarely provide substantial lasting relief. Cases This report describes how a simple and easy to perform acupuncture technique-interosseous membrane stimulation-was used to treat painful neuropathy in 3 patients: 1 with painful diabetic neuropathy; 1 with idiopathic painful neuropathy; and 1 with painful neuropathy caused by exposure to Agent Orange while serving in Vietnam. Results The 3 patients had much relief from the pain associated with their neuropathy for several weeks at a time. With regular treatments, sustained relief was obtained any without the addition of new medication. Conclusions Interosseous membrane stimulation is safe, simple, and effective for treatment of painful neuropathy. This treatment should be considered for patients who are suffering with painful neuropathy.
Collapse
Affiliation(s)
- Michael Freedman
- Greenville VA HealthCare Center—Specialty Clinics, Greenville, NC, USA
| | | |
Collapse
|
7
|
Reissig LF, Carrero-Rojas G, Maierhofer U, Moghaddam AS, Hainfellner A, Gesslbauer B, Haider T, Streicher J, Aszmann OC, Pastor AM, Weninger WJ, Blumer R. Spinal cord from body donors is suitable for multicolor immunofluorescence. Histochem Cell Biol 2023; 159:23-45. [PMID: 36201037 PMCID: PMC9899749 DOI: 10.1007/s00418-022-02154-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2022] [Indexed: 02/07/2023]
Abstract
Immunohistochemistry is a powerful tool for studying neuronal tissue from humans at the molecular level. Obtaining fresh neuronal tissue from human organ donors is difficult and sometimes impossible. In anatomical body donations, neuronal tissue is dedicated to research purposes and because of its easier availability, it may be an alternative source for research. In this study, we harvested spinal cord from a single organ donor 2 h (h) postmortem and spinal cord from body donors 24, 48, and 72 h postmortem and tested how long after death, valid multi-color immunofluorescence or horseradish peroxidase (HRP) immunohistochemistry is possible. We used general and specific neuronal markers and glial markers for immunolabeling experiments. Here we showed that it is possible to visualize molecularly different neuronal elements with high precision in the body donor spinal cord 24 h postmortem and the quality of the image data was comparable to those from the fresh organ donor spinal cord. High-contrast multicolor images of the 24-h spinal cords allowed accurate automated quantification of different neuronal elements in the same sample. Although there was antibody-specific signal reduction over postmortem intervals, the signal quality for most antibodies was acceptable at 48 h but no longer at 72 h postmortem. In conclusion, our study has defined a postmortem time window of more than 24 h during which valid immunohistochemical information can be obtained from the body donor spinal cord. Due to the easier availability, neuronal tissue from body donors is an alternative source for basic and clinical research.
Collapse
Affiliation(s)
- Lukas F. Reissig
- Division of Anatomy, MIC, Medical University Vienna, Vienna, Austria
| | | | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Bernhard Gesslbauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Haider
- Department of Orthopedic and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Johannes Streicher
- Department of Anatomy and Biomechanics, Division of Anatomy and Developmental Biology, Karl Landsteiner University of Health Science, Krems an der Donau, Austria
| | - Oskar C. Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Vienna, Austria
| | - Angel M. Pastor
- Departamento de Fisiología, Facultad de Biología, Universidad de Sevilla, Seville, Spain
| | | | - Roland Blumer
- Division of Anatomy, MIC, Medical University Vienna, Vienna, Austria
| |
Collapse
|
8
|
Meklef RA, Siemers F, Rein S. Development of a 3D-immunofluorescence analysis for sensory nerve endings in human ligaments. J Neurosci Methods 2022; 382:109724. [PMID: 36207004 DOI: 10.1016/j.jneumeth.2022.109724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The analysis of ligamentous mechanoreceptors is difficult due to a high amount of unclassifiable mechanoreceptors, which result from incomplete visualization through limited microscopic techniques. NEW METHOD The method was developed using dorsal intercarpal ligaments and dorsal regions of the scapholunate interosseous ligament from human cadaver wrists. Consecutive 70 µm thick cryosections were stained with immunofluorescence markers for protein S100B, neurotrophin receptor p75 (p75), protein gene product 9.5 (PGP 9.5) and 4',6-diamidino-2-phenylindole (DAPI). 3D images of sensory nerve endings were obtained using a confocal laser scanning microscope. Experimental point spread functions (PSF) were used to deconvolve images. Sensory nerve endings were localised in each section plane and classified according to Freeman and Wyke. Finally, confocal data was visualized as 3D-images. RESULTS The method produced excellent image quality, revealing detailed three-dimensional structures. The created 3D-model of sensory nerve endings could be analyzed in all three dimensions, augmenting visualization of the form and immunoreactive pattern of sensory nerve endings. Deconvolution with experimentally measured PSFs aided in enhancing image quality. COMPARISON WITH EXISTING METHODS Using a triple immunofluorescent staining method allows to visualize the structure of sensory nerve endings more precisely than techniques with serial analysis of different monostaining of neural markers. Imaging in three dimensions enhances morphologic details, which are limited in 2D-microscopy. CONCLUSION 3D-triple immunofluorescence produces high quality visualization of mechanoreceptors, thereby improving their analysis. As an elaborate technique, it is ideal for defined research questions concerning the microstructure of sensory nerve endings.
Collapse
Affiliation(s)
- Rami Al Meklef
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Germany
| | - Frank Siemers
- Martin-Luther-University Halle-Wittenberg, Germany; Department of Plastic and Hand Surgery with Burn Unit, Trauma Center Bergmannstrost, 06112 Halle, Germany
| | - Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Klinikum Sankt Georg, Delitzscher Straße 141, 04129 Leipzig, Germany; Martin-Luther-University Halle-Wittenberg, Germany.
| |
Collapse
|
9
|
Rein S, Esplugas M, Garcia-Elias M, Kremer T, Siemers F, Lühmann P. Immunofluorescence analysis of sensory nerve endings in the periarticular tissue of the human elbow joint. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04604-0. [PMID: 36070088 DOI: 10.1007/s00402-022-04604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To investigate the dynamic aspects of elbow stability, we aimed to analyze sensory nerve endings in the ligaments and the capsule of elbow joints. MATERIALS AND METHODS The capsule with its anterior (AJC) and posterior (PJC) parts, the radial collateral ligament (RCL), the annular ligament (AL), and the ulnar collateral ligament with its posterior (PUCL), transverse (TUCL) and anterior parts (AUCL) were dissected from eleven human cadaver elbow joints. Sensory nerve endings were analyzed in two levels per specimen as total cell amount/ cm2 after immunofluorescence staining with low-affinity neurotrophin receptor p75, protein gene product 9.5, S-100 protein and 4',6-Diamidin-2-phenylindol, Carbonic anhydrase II and choline acetyltransferase on an Apotome microscope according to Freeman and Wyke's classification. RESULTS Free nerve endings were the predominant mechanoreceptor in all seven structures followed by Ruffini, unclassifiable, Golgi-like, and Pacini corpuscles (p ≤ 0.00001, respectively). Free nerve endings were observed significant more often in the AJC than in the RCL (p < 0.00002). A higher density of Ruffini endings than Golgi-like endings was observed in the PJC (p = 0.004). The RCL contained significant more Ruffini endings than Pacini corpuscles (p = 0.004). Carbonic anhydrase II was significantly more frequently positively immunoreactive than choline acetyltransferase in all sensory nerve endings (p < 0.05). Sensory nerve endings were significant more often epifascicular distributed in all structures (p < 0.006, respectively) except for the AJC, which had a pronounced equal distribution (p < 0.00005). CONCLUSION The high density of free nerve endings in the joint capsule indicates that it has pronounced nociceptive functions. Joint position sense is mainly detected by the RCL, AUCL, PUCL, and the PJC. Proprioceptive control of the elbow joint is mainly monitored by the joint capsule and the UCL, respectively. However, the extreme range of motion is primarily controlled by the RCL mediated by Golgi-like endings.
Collapse
Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany. .,Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
| | - Mireia Esplugas
- Kaplan Hand Institute, Paseo de la Reina Elisenda 17, 08034, Barcelona, Spain
| | - Marc Garcia-Elias
- Kaplan Hand Institute, Paseo de la Reina Elisenda 17, 08034, Barcelona, Spain
| | - Thomas Kremer
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany
| | - Frank Siemers
- Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Merseburger Straße 165, 06112, Halle (Saale), Germany
| | - Paul Lühmann
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Delitzscher Straße 141, 04129, Leipzig, Germany.,Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
10
|
Garcia-Elias M, Ananos D, Esplugas M, Hagert E, Heras-Palou C, Kakar S. Ligaments and muscles stabilizing the radio-ulno-carpal joint. J Hand Surg Eur Vol 2022; 47:65-72. [PMID: 34472392 DOI: 10.1177/17531934211042316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The technical simplicity of the Darrach procedure may explain why it has been so popular. Excising the distal ulna, however, may have potentially undesired consequences to the biomechanics in two areas: the distal radioulnar and the ulno-carpal joints. These conjointly define the radio-ulno-carpal joint (RUCJ). The RUCJ is not a small and irrelevant articulation that can be removed without possibly paying a functional penalty. It is an important link of the antebrachial frame that provides stability to the distal forearm and the carpus. This article revisits the mechanisms by which some ligaments and muscles ensure that all forces about and within the RUCJ are dealt with efficiently.
Collapse
Affiliation(s)
| | - Dirck Ananos
- Royal Perth Hospital, Fremantle Hand Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Mireia Esplugas
- Hand and Upper Limb Surgery, Institut Kaplan, Barcelona, Spain
| | - Elisabet Hagert
- Department of Clinical Science and Education, Karolinska Instituten, Stockholm, Sweden.,Musculoskeletal & Sports Injury Epidemiology Center, Sophiahemmet University, Stockholm, Sweden
| | | | | |
Collapse
|
11
|
Role of the interosseous membrane in post-traumatic forearm instability: instructional review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2619-2633. [PMID: 34331102 DOI: 10.1007/s00264-021-05149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In the last two decades, a strong interest on the interosseous membrane (IOM) has developed. METHODS The authors present a review of the new concepts regarding the understanding of forearm physiology and pathology, with current trends in the surgical management of these rare and debilitating injuries. RESULTS Anatomical and biomechanical studies have clarified the anatomy of forearm constrains and their role in forearm longitudinal and transverse stability. The radial pull test, a new intraoperative test, has been developed that might increase the detection on IOM injuries. The forearm is now considered a "functional unit" and, consequently, a new classification has been proposed. Uncommon variants and rare patterns of forearm fracture dislocations have been reported in the literature and could not be classified to those commonly referred to using eponyms (Monteggia, Galeazzi, Essex-Lopresti). The new Artiaco et al. classification includes all injury patterns, thus avoids confusion in the nomenclature, and helps surgeon with detection of lesions and guiding surgical treatment. CONCLUSION Based on the new classification and after current literature review, authors propose a management flowchart for treatment of forearm instability injuries.
Collapse
|
12
|
Structural topography of the interosseous membrane of the human forearm. Ann Anat 2020; 231:151547. [PMID: 32512201 DOI: 10.1016/j.aanat.2020.151547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 02/05/2020] [Accepted: 05/20/2020] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate the morphology of the six different parts of the interosseous membrane (IOM) in 11 human cadaver forearms, including 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). Hematoxylin-eosin and Elastica van Gieson stained slices were used to investigate the tissue morphology. The DOB and DOAC were absent in one IOM and the POB in two IOMs, respectively. The CB and DAB were longer than all other structures except for each other. The DOAC was longer than the DOB. The DAB, CB, and PAB, were broader than the DOB, DOAC, and POC. No significant differences were observed regarding structure thickness. All structures were found to consist of densely packed parallel collagen fiber arrangement. The DOB and POC had a higher amount of elastic fibers in the fascicular collagen tissue than the other structures. Elastic fibers were more often equally distributed throughout the structures than condensed epifascicular or at the insertion into bone. The tight parallel collagen composition within the different structures reflects the central stabilizing role of the IOM in the forearm. The higher amount of elastic fibers within the DOB and POC can be attributed to their location close to the distal and proximal radioulnar joints, respectively. Here elastic fibers allow adaption to forearm rotation, whereas the structures of the central part of IOM have less elasticity reflecting the predominant stabilizing function.
Collapse
|
13
|
Carrillo F, Suter S, Casari FA, Sutter R, Nagy L, Snedeker JG, Fürnstahl P. Digitalization of the IOM: A comprehensive cadaveric study for obtaining three-dimensional models and morphological properties of the forearm's interosseous membrane. Sci Rep 2020; 10:6401. [PMID: 32286490 PMCID: PMC7156465 DOI: 10.1038/s41598-020-63436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
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.
Collapse
Affiliation(s)
- Fabio Carrillo
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland. .,Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, CH-8008, Zurich, Switzerland.
| | - Simon Suter
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Fabio A Casari
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland.,Department of Orthopaedics, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Ladislav Nagy
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland.,Department of Orthopaedics, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, CH-8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| |
Collapse
|