1
|
Luo C, Sun Y, Bian H, Liu H, Liu T, Tan J. Length Changes in the Interosseous Membrane During Forearm Rotation: A 3-Dimensional Study In Vivo. J Hand Surg Am 2024; 49:486.e1-486.e5. [PMID: 35940998 DOI: 10.1016/j.jhsa.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 04/18/2022] [Accepted: 06/07/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The length change of the interosseous membrane (IOM) during forearm rotation has not been fully studied. To explore the meaning of length change in the distal oblique band (DOB), the distal accessory band (DAB), and the proximal, middle, and distal parts of the central band (CBP, CBM, and CBD, respectively), we investigated the length change in these ligaments at maximum pronation, 45° of pronation, neutral position, 45° of supination, and maximum supination in vivo. METHODS The images of the right forearms from 6 healthy volunteers were obtained by computed tomography scanning at the 5 above-mentioned rotation positions. We created 3-dimensional models of the radius and ulna, DOB, DAB, and central band based on the points of origin and insertion. Finally, the length of each ligament was estimated from the points of insertions and origins registered on the 3-dimensional models. RESULTS The DAB and CBD lengths increased significantly from maximum pronation to 45° of pronation. The DOB length increased significantly from 45° of pronation to neutral position and decreased significantly from 45° of supination to maximum supination. The DAB and CBM lengths increased significantly from neutral position to 45° of supination. The DAB length decreased significantly from 45° of supination to maximum supination. For the CBP, no difference in length was observed during forearm rotation. CONCLUSIONS The DOB becomes taut at neutral position, and the central band, especially the CBP, is nearly isometric. The findings indicate that the DOB may provide the primary stabilization of the distal radioulnar joint and that the central band is the key stabilizer during forearm rotation. CLINICAL RELEVANCE Surgeons may pay attention to the DOB when a patient incurs a distal radioulnar joint injury, and the CBP may be the optimal location for IOM reconstruction.
Collapse
Affiliation(s)
- Chunbing Luo
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Haoyu Bian
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Hua Liu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Tingting Liu
- Department of Medical Imaging, Affiliated Hospital of Nantong University, Nantong, China
| | - Jun Tan
- Department of Hand Surgery, Affiliated Hospital of Nantong University, College of Medicine, University of Nantong, Nantong, China.
| |
Collapse
|
2
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
3
|
Angelis S, Apergis E, Kanellos P, Apostolopoulos A, Vlasis K, Piagkou M, Filippou D. The Distal Oblique Bundle in the Distal Forearm: From Anatomical Features to Clinical Implementation. Cureus 2023; 15:e50252. [PMID: 38196414 PMCID: PMC10774832 DOI: 10.7759/cureus.50252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
Background and objective The distal oblique bundle (DOB) is nowadays recognized as the thickest component of the distal interosseous membrane (DIOM). It is neither thought to be a clear-cut ligament, and nor does it follow the typical configuration of the rest of the DIOM. It is not always present and some studies have raised disputes about its prevalence and a few anatomical features. In this study, we aimed to provide data on the prevalence and anatomical features of the DOB, which are of great importance at this early stage of research into the topic. Our findings have been correlated with current knowledge and are expected to contribute to clinical implementation. Materials and methods Twenty-eight fresh-frozen forearms were utilized for measurements. Specifically, mean length, width, distance from the middle of the bundle's insertion to the ulna to the tip of the styloid process of the ulna, as well as the distance from the midpoint of its insertion to the radius to the tip of the radiuses' styloid process were calculated. The prevalence was described with a cutoff thickness point of 0.5 mm. Early results based on three cases of DOB reconstruction with the "Riggenbach" technique due to distal radioulnar joint (DRUJ) instability were documented. Results Eleven DOBs were reported out of the 28 specimens, suggesting a prevalence of 39.3%. The mean thickness was 0.88 mm (range: 0.6-1.3 mm), the mean width was 5.22 mm (range: 2.2-8.4 mm), and the mean length was 25.68 mm (range: 22.7-29.2 mm). Proximally, the mean distance from the bundle's ulnar insertion to the tip of the styloid process of the ulna was 51.02 mm (range: 45.5-55.6 mm) while distally, the mean distance from the bundle's insertion to the radius to the tip of the styloid process of the radius was 34.5 mm (range: 31.3-37.7 mm). After a follow-up of at least six months, improvement was evident in all measured areas in the three patients who underwent surgery. Additionally, they reported satisfaction and accomplishment of their preoperative goals. Conclusions Discrepancies in measurements in some anatomic features between studies are probably due to variations in specimen types, measurement methods, and sites. Efforts must continue to be made on a more extensive scale and in a more standardized manner for more factual results and conclusions. "Reconstruction-recreation" or "original construction-creation" procedures yield promising results in a fast, simple, and less invasive manner than traditional methods of DRUJ stabilization.
Collapse
Affiliation(s)
- Stavros Angelis
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
- Orthopaedics, General Hospital Hellenic Red Cross Korgialenio - Benakio, Athens, GRC
| | - Emmanouil Apergis
- Orthopaedics, General Hospital Hellenic Red Cross Korgialenio - Benakio, Athens, GRC
| | | | | | | | - Maria Piagkou
- Anatomy, National and Kapodistrian University of Athens, Athens, GRC
| | | |
Collapse
|
4
|
Oeckenpöhler S, Langer MF, Riesenbeck O. Missed Essex-Lopresti Injury-Development of a Combined Proximal and Distal Radio-Ulnar Joint Prosthesis as a Treatment Option and Proof of Concept. Healthcare (Basel) 2023; 11:2274. [PMID: 37628472 PMCID: PMC10454874 DOI: 10.3390/healthcare11162274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Essex-Lopresti injuries are characterized by injuries to the proximal radio-ulnar joint, the distal radio-ulnar joint, and the interosseous membrane. This can lead to osteoarthritis, impaction syndrome, or instability. If all three structures are injured and lead to instability, the situation is almost unmanageable and many times ends in a one-bone forearm. In this article, we demonstrate a new way to reconstruct the proximal and distal radio-ulnar joint with two patient-specific coupled prostheses. These have been developed with the biomechanical conditions of the forearm in mind, where there are very large forces between the bones. As a result, we are able to present a patient previously severely restricted in the use of his hand and arm via a splint that compressed the forearm, who is now able to perform everyday activities and even light sports, such as badminton, without pain.
Collapse
Affiliation(s)
| | - Martin Franz Langer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Waldeyer Str. 1, 48149 Muenster, Germany; (S.O.)
| | | |
Collapse
|
5
|
Poitevin LA, Postan D, Valente S. Distal-Ulna Stump Stability: The Role of Distal Interosseous Membrane: Myth or Reality? Anatomical Research. Hand (N Y) 2022; 17:12S-18S. [PMID: 34144664 PMCID: PMC9793619 DOI: 10.1177/1558944721999728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Distal-ulna stump (DUS) instability often occurs when performing a distal radioulnar joint (DRUJ) arthroplasty. Recent studies suggest that the distal interosseous membrane (DIOM) reinforces the triangular fibrocartilage complex, providing additional stability to the DRUJ. The aim of this study was to determine whether the DIOM stabilizes the ulnar stump. METHODS Twenty fresh-frozen random forearms were dissected. The presence of a distal oblique bundle (DOB) was recorded and measured. The radius was fixed to a vise and the ulna kept free. The DRUJ was fixed with a lag screw. A bone slice was removed by transverse ulna osteotomies 10 and 15 mm proximal to the DRUJ. A 10-N force was applied to the ulna in dorsal and volar directions. Displacements were measured. The DIOM was then transected, and maneuvers and measurements were repeated and compared. RESULTS A distinct distal membrane was present in 70% and a cord-like DOB in 30%. The mean length was 29 mm. Its origin was proximal to the sigmoid notch; its insertion was on the distal third of the ulna, at its lateral border. This attachment is comprised between 39 and 48 mm proximal to the ulnocarpal joint. Initial displacements averaged 22 mm dorsally and 13 mm volarly. After DIOM transection, ulnar translocation increased to 31 mm dorsally and 19 mm volarly. CONCLUSION In DRUJ arthroplasties, the DIOM does not appear to be a stabilizer of the DUS beneath a useful threshold. Its retaining effect occurs only after an initial 22-mm dorsal displacement, which we consider not clinically admissible. Therefore, in DRUJ arthroplasties, some augmentation might be advisable.
Collapse
Affiliation(s)
- Luciano A. Poitevin
- University of Buenos Aires,
Argentina
- Buenos Aires University Hospital,
Argentina
| | - Daniel Postan
- University of Buenos Aires,
Argentina
- Hospital de Quemados, Buenos Aires,
Argentina
| | - Sergio Valente
- University of Buenos Aires,
Argentina
- Hospital Municipal “Dr. Marcelo T.
Orellana”, Trenque Lauquen, Argentina
| |
Collapse
|
6
|
Rougereau G, Marty-Diloy T, Vigan M, Vialle R, Soubeyrand M, Langlais T. Biomechanical assessment of the central band of the interosseous membrane using shear wave elastography: reliability and reproducibility. J Hand Surg Eur Vol 2022; 47:1134-1141. [PMID: 35953882 DOI: 10.1177/17531934221114301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
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.
Collapse
Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Adult Orthopedic Surgery, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France
| | - Marie Vigan
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, Boulogne-Billancourt, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris
| | - Marc Soubeyrand
- Department of Orthopedics and Traumatology, Clinique Saint Jean l'Ermitage, Melun, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Pediatric Orthopedic Surgery, Toulouse University, Children's hospital, Purpan, Toulouse, France
| |
Collapse
|
7
|
Kholinne E, Kwak JM, Sun Y, Koh KH, Jeon IH. Forearm Interosseous Ligaments: Anatomical and Histological Analysis of the Proximal, Central, and Distal Bands. J Hand Surg Am 2021; 46:1029.e1-1029.e8. [PMID: 33892984 DOI: 10.1016/j.jhsa.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/23/2020] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize and compare the histological structure of the proximal, central, and distal bands of the interosseous membrane (IOM) of the human forearm in fresh-frozen specimens. METHODS The IOMs from 16 fresh-frozen left forearm specimens were carefully dissected and examined. The footprint areas of the proximal, central, and distal IOM bands were measured in 6 specimens. The histological characteristics of the IOM bands were evaluated using hematoxylin-eosin and Masson trichrome staining protocols in 10 specimens as histological analysis necessitated an intact footprint. The footprint areas of the IOM were measured using an image processing program. The insertion complex was assessed using a light microscope. RESULTS Histological assessment revealed that the IOM structure demonstrated similarities with ligament structure. The average footprint areas of the proximal, central, and distal bands at the radial site were 11.1 ± 0.8, 180.4 ± 30.4, and 10.7 ± 1.3 mm2, respectively. At the ulnar site, they were 11.0 ± 1.1, 171.8 ± 30.1, and 10.7 ± 1.2 mm2, respectively. The insertion complex of the IOM into the bone comprised 4 layers: (1) interwoven collagen, (2) oblique collagen, (3) mineralized fibrocartilage (tidemark), and (4) lamellar bone. The average tidemark zone thicknesses of the proximal, central, and distal bands were 20.1 ± 6.3, 107.8 ± 22.9, and 20.6 ± 4.7 μm, respectively at the radial site and 12.0 ± 4.5, 85.7 ± 23.2, and 13.5 ± 6.9 μm, respectively at the ulnar site. CONCLUSIONS In this study, we confirm that the histological characteristics of the IOM are similar to those of ligaments. Compared with the proximal and distal bands, the central band has a greater footprint area and thicker tidemark zone. CLINICAL RELEVANCE If surgical reconstruction is performed, the size and histological characteristics of the graft should be similar to those of the native ligaments.
Collapse
Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia; Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea.
| |
Collapse
|
8
|
Lee HS, Kim WJ, Young KW, Jeong GM, Yeo ED, Lee YK. Comparison of Open Anterior Syndesmotic Repair Augmented With Suture-Tape and Trans-syndesmotic Screw Fixation: A Biomechanical Study. J Foot Ankle Surg 2021; 60:339-344. [PMID: 33431315 DOI: 10.1053/j.jfas.2020.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/22/2020] [Accepted: 04/01/2020] [Indexed: 02/03/2023]
Abstract
The treatment of syndesmotic injuries with ankle fractures is controversial. The purpose of this study was to compare the biomechanical properties of open anterior syndesmotic repair with those of screw fixation. Ten matched pairs of human cadaver specimens were subjected to open syndesmotic repair or screw fixation. Each specimen underwent initial intact physiologic loading, consisting of 10 cycles of external torsional loading with a peak torque of 7.5 Nm at 0.05 Hz. Injuries of the anterior inferior tibiofibular ligament, tibiofibular interosseous membrane, and deltoid ligament were applied to each specimen. Postfixation cyclic loading consisted of 50 cycles of combined axial and external rotation loading with peak torques of 750 N and 7.5 Nm at a rate of 0.05 Hz. After postfixation loading, each specimen underwent failure loading by external rotation at 0.25 degrees/second. Failure torque and failure angle were measured. The paired t test and Wilcoxon signed-rank test were used to analyze the data. Mean failure torques were 95.63 Nm in the open anterior syndesmotic repair augmented with suture-tape group and 108.61 Nm in the screw group. Mean failure angles were 34.93 degrees in the open anterior syndesmotic repair augmented with suture-tape group and 43.55 degrees in the screw group. These data were not statistically significantly different between the groups (p= .7682 and .4133, respectively). Open anterior syndesmotic repair augmented with suture tape for ankle syndesmotic injury provides similar torsional strength to that of screw fixation. Therefore, this technique can be considered as an alternative treatment option for syndesmosis injury.
Collapse
Affiliation(s)
- Hong Seop Lee
- Professor, Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Woo Jong Kim
- Professor, Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | - Ki Won Young
- Professor, Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Gu Min Jeong
- Resident, Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Eui Dong Yeo
- Surgeon, Department of Orthopedic Surgery, Veteran Health Service Medical Center, Seoul, Korea
| | - Young Koo Lee
- Professor, Department of Orthopedic Surgery, College of Medicine, Soonchunhyang University Bucheon Hospital, Gyunggi-do, Korea.
| |
Collapse
|
9
|
Kholinne E, Kwak JM, Sun Y, Koh KH, Jeon IH. The role of the interosseous ligament in forearm rotation: A bio-mechanical study. J Orthop Surg (Hong Kong) 2021; 28:2309499020973481. [PMID: 33300440 DOI: 10.1177/2309499020973481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Management of longitudinal forearm instability remains challenging. Chronic forearm stability may be overcome by reconstruction of the interosseous ligament (IOL). Despite the bands of the IOL being inseparable, studies of the IOL have focused on the central band (CB), but have neglected the proximal (PB) and distal (DB) bands. The purpose of this study was to characterize the bio-mechanical properties of the IOL. MATERIALS AND METHODS Twelve frozen specimens from individuals of both sexes were bio-mechanically analyzed using a custom-designed jig operated at constant angular speed to simulate forearm rotation. Strain was measured during dynamic forearm simulation using a motion tracking system. RESULTS The average strain of the CB, PB, and DB during forearm simulation were 0.08 ± 0.04, 0.83 ± 0.47, and 0.65 ± 0.23 mm (p < 0.001). The IOL was generally shortest during maximal pronation and increased as the forearm was rotated to a neutral position. The strain of the CB remain constant during forearm rotation and was the lowest at full pronation to 20° pronation position. Throughout forearm rotation, the strain of the CB remained constant, whereas the strain of the PB and DB fluctuated. CONCLUSIONS The PB, CB, and DB of the forearm IOL have different bio-mechanical properties. CB maintained a constant rotational strain throughout forearm rotation. Strain on the CB was significantly lower than strains on the PB and DB. By contrast, strains on the PB and DB varied, suggesting that their roles differ from those of the CB. When CB reconstruction is needed, graft should be tensioned at 20° forearm pronation to gain optimum tension.
Collapse
Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia.,Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
10
|
Riegleman DL, Creech JA. Successful Treatment of Medial Tibial Stress Syndrome with Interosseous Membrane Acupuncture: A Case Series. Med Acupunct 2021; 33:150-152. [PMID: 33912272 DOI: 10.1089/acu.2020.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Medial tibial stress syndrome (MTSS), otherwise known as shin splints, frequently causes pain and disability in the physically active population and can be recalcitrant to treatment. Interventional and alternative therapies, specifically acupuncture, for treatment of MTSS have been poorly described in the literature. The aim of this case series is to describe an acupuncture technique for the treatment of MTSS. Cases: Patients who received the diagnosis of MTSS were treated in an outpatient military treatment facility. One Hwato® 0.30 mm × 75 mm needle was placed 1 cun distal and 1 cun lateral to the tibial tuberosity of the affected leg and was inserted deeply through the plane of the interosseous membrane. A second needle was then placed 2 cun distal to the first needle in the same trajectory and at the same depth. Needles were then irregularly stimulated for 5 minutes before needle removal. After treatment, the patient vigorously moved the affected leg before reassessing pain. Results: Both patients noted a clinically significant decrease in pain immediately after intervention, which lasted for 4 weeks. Conclusions: Interosseous membrane acupuncture is a clinically significant, effective means to decrease MTSS-associated pain in physically active adults. This case series demonstrates a technique to augment conservative therapy of patients with MTSS.
Collapse
Affiliation(s)
- David Lee Riegleman
- SAUSHEC Pain Medicine Fellowship, Medical Education Department, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Julie A Creech
- Eglin Family Medicine Residency, 96th Medical Group, Eglin Air Force Base, FL, USA
| |
Collapse
|
11
|
Rushing CJ, Spinner SM, Armstrong AV, Hardigan P. Comparison of Different Magnitudes of Applied Syndesmotic Clamp Force: A Cadaveric Study. J Foot Ankle Surg 2021; 59:452-456. [PMID: 32354500 DOI: 10.1053/j.jfas.2019.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/12/2019] [Accepted: 08/29/2019] [Indexed: 02/03/2023]
Abstract
Overcompression of the ankle syndesmosis was once thought to be improbable. Recent studies using computerized tomography (CT) however, have demonstarted otherwise; raising pertinent questions regarding the factors associated with and consequences of syndesmotic overcompression. The purpose of the present study was to directly compare different magnitudes of applied clamp force on the coronal reduction of ankle syndesmosis. Eight through-the-knee cadaveric specimens were obtained. Fiducial cannulated screws were placed in the tibia and fibula to standardize placement of the reduction clamp's tines. CT scans were obtained as baseline controls, followed by destabilization of the syndesmosis. Reductions were then performed using a clamp equipped with an inline load cell, and objective forces (60, 80, 100, 120, 140, and 160 N) applied sequentially to each of the specimens. The syndesmosis was fixed with a single quadricortical screw, and CT were scans repeated. Applied clamp forces of 60 and 80 N resulted in lateral fibular displacement and undercompression (42.9% and 57.1%, respectively), whereas forces of 140 and 160 N resulted in medial fibular displacement (p = .011 and p = .001) and overcompression (100%). The smallest mediolateral displacements were observed with 100 and 120 N, respectively. Malreduction assessment with CT was superior to traditional radiographs [r(54) = 0.22; 95% confidence interval -0.04 to 0.45; p = .101]. In our cadaveric model, an applied clamp force of 100 N most effectively mitigated iatrogenic coronal syndesmotic malreduction from under- or overcompression. Although additional research is warranted, based on the data, inherent variabilities in the applied clamp force by surgeons appear to contribute to the unacceptably high coronal syndesmotic malreduction rate.
Collapse
Affiliation(s)
- Calvin J Rushing
- Foot and Ankle Surgeon, Westside Regional Medical Center, Plantation, FL; Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL.
| | - Steven M Spinner
- Foot and Ankle Surgeon, Westside Regional Medical Center, Plantation, FL; Board Member, Foot and Ankle Research Foundation of South Florida Inc., Plantation, FL
| | - Albert V Armstrong
- Director of Radiology, Barry University School of Podiatric Medicine & Surgery, Miami, FL
| | - Patrick Hardigan
- Professor, Nova Southeastern University College of Osteopathic Medicine, Ft. Lauderdale, FL
| |
Collapse
|
12
|
Badre A, Axford DT, Padmore CE, Berkmortel C, Faber KJ, Johnson JA, King GJW. Effect of ulnar angulation and soft tissue sectioning on radial head stability in anterior Monteggia injuries: an in vitro biomechanical study. J Shoulder Elbow Surg 2020; 29:1249-1258. [PMID: 32044251 DOI: 10.1016/j.jse.2019.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/20/2019] [Accepted: 10/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radial head instability continues to be a challenge in the management of anterior Monteggia injuries; however, there is a paucity of literature on the factors that contribute to this instability. The aim of this biomechanical investigation was to examine the effects of ulnar angulation and soft tissue insufficiency on radial head stability in anterior Monteggia injuries. METHODS Six cadaveric arms were mounted in an elbow motion simulator. Radial head translation was measured during simulated active elbow flexion with the forearm supinated. After testing the elbows in the intact state, the ulna was osteotomized and tested at 0°, 10°, 20°, and 30° of extension angulation. To examine the effect of soft tissue insufficiency, the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane (IOM) were sequentially sectioned. RESULTS There was a significant increase in anterior radial head translation with greater ulnar extension angulation. Sequential soft tissue sectioning also significantly increased anterior radial head translation. There was no increase in radial head translation with isolated sectioning of the anterior radiocapitellar joint capsule. Additional sectioning of the annular ligament and quadrate ligament slightly increased anterior radial head translation but did not reach statistical significance. Subsequent sectioning of the proximal and middle IOM resulted in significant increases in anterior radial head translation. CONCLUSION Our study demonstrates that progressive ulnar extension angulation results in an incremental increase in anterior radial head translation in anterior Monteggia injuries. Moreover, increasing magnitudes of soft tissue disruption result in greater anterior radial head instability.
Collapse
Affiliation(s)
- Armin Badre
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, London, ON, Canada.
| | - David T Axford
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Clare E Padmore
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Carolyn Berkmortel
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Kenneth J Faber
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, London, ON, Canada
| | - James A Johnson
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Graham J W King
- Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, London, ON, Canada
| |
Collapse
|
13
|
Rein S, Esplugas M, Garcia-Elias M, Magin TM, Randau TM, Siemers F, Philipps HM. Immunofluorescence analysis of sensory nerve endings in the interosseous membrane of the forearm. J Anat 2019; 236:906-915. [PMID: 31863467 DOI: 10.1111/joa.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/20/2019] [Indexed: 12/22/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Susanne Rein
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| | | | | | - Thomas M Magin
- Division of Cell and Developmental Biology, Institute of Biology, University of Leipzig, Leipzig, Germany
| | - Thomas M Randau
- Department of Orthopaedic and Trauma Surgery, University Hospital Bonn, Bonn, Germany
| | - Frank Siemers
- Department of Plastic and Hand Surgery, Burn Unit, Trauma Center Bergmannstrost, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hubertus M Philipps
- Department of Plastic and Hand Surgery, Burn Unit, Hospital Sankt Georg, Martin-Luther-University Halle-Wittenberg, Leipzig, Germany
| |
Collapse
|
14
|
Komatsu J, Nagura N, Mogami A, Iwase H, Kaneko K. Seven-year follow-up for malrotation of a radial diaphysis fracture in a child corrected by osteotomy for loss of motion: A case report. Exp Ther Med 2019; 18:3009-3013. [PMID: 31572542 PMCID: PMC6755442 DOI: 10.3892/etm.2019.7932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/01/2019] [Indexed: 11/06/2022] Open
Abstract
A greenstick fracture is an incomplete fracture where the compressive side of the cortex is still intact but plastically deformed. The incidence of poor results following the closed treatment of greenstick fractures in children >10 years of age is seriously underestimated. Therefore, fixing the position of the forearm is important for initial treatment. In cases of greenstick fracture, the possibility of inadequate remodeling of angulated deformities during growth, and in particular, the lack of correction between rotational malalignment and growth when the diaphyseal forearm is involved in the fracture, should be considered. A male, 10-year-old, left hand-dominant, Asian patient fell while playing in the garden and was immediately assessed by an orthopedic doctor at an Emergency Orthopaedic Clinic. Initial examination revealed a deformity of his dominant left forearm and an angulated greenstick fracture of the radius. However, after 3 months, he developed loss of supination of his left forearm and complained of limitation of left forearm supination. Radiography demonstrated a volar angulation of 20°. The patient underwent open reduction, internal fixation and 10° bending with a plate for correction without corrective rotation. At 12 months after injury, the patient did not exhibit pain or limitation of the elbow and wrist. After follow-up for 7 years, the patient was able to perform normal day-to-day activities with no adverse symptoms. The present case indicated that corrective osteotomy is required following the loss of supination after a greenstick fracture of the diaphysis of the radius. The patient of the current study exhibited rotation due to the central band of the interosseous membrane. In the treatment of greenstick fractures, a radius apex angulation of 20° must be corrected via osteotomy due to loss of rotation. The present case indicated that corrective osteotomy of the radius apex alone without rotational correction, in combination with plate bending improved the loss of forearm rotation.
Collapse
Affiliation(s)
- Jun Komatsu
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Nana Nagura
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Atsuhiko Mogami
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka 410-2295, Japan
| | - Hideaki Iwase
- Department of Bio-Engineering, Juntendo University Institute of Casualty Center, Izunokuni, Shizuoka 410-2295, Japan
| | - Kazuo Kaneko
- Department of Medicine for Motor Organs, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo 113-8421, Japan
| |
Collapse
|
15
|
Wagner E, Wagner P, Zanolli D, Radkievich R, Redenz G, Guzman R. Biomechanical Evaluation of Circumtibial and Transmembranous Routes for Posterior Tibial Tendon Transfer for Dropfoot. Foot Ankle Int 2018. [PMID: 29528722 DOI: 10.1177/1071100718760845] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibialis posterior tendon transfer is performed when loss of dorsiflexion has to be compensated. We evaluated the circumtibial (CT), above-retinaculum transmembranous (TMAR), and under-retinaculum transmembranous (TMUR) transfer gliding resistance and foot kinematics in a cadaveric foot model during ankle range of motion (ROM). METHODS Eight cadaveric foot-ankle distal tibia specimens were dissected free of soft tissues on the proximal end, applying an equivalent force to 50% of the stance phase to every tendon, except for the Achilles tendon. Dorsiflexion was tested with all of the tibialis posterior tendon transfer methods (CT, TMAR, and TMUR) using a tension tensile machine. A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each transfer. Foot motion and the force needed to achieve dorsiflexion were recorded. RESULTS The CT transfer showed the highest gliding resistance ( P < .01). Regarding kinematics, all transfers decreased ankle ROM, with the CT transfer being the condition with less dorsiflexion compared with the control group (6.8 vs 15 degrees, P < .05). TMUR transfer did perform better than TMAR with regard to ankle dorsiflexion, but no difference was shown in gliding resistance. The CT produced a supination moment on the forefoot. CONCLUSION The CT transfer had the highest tendon gliding resistance, achieved less dorsiflexion and had a supination moment. Clinical Relevance We suggest that the transmembranous tibialis posterior tendon transfer should be the transfer of choice. The potential bowstringing effect when performing a tibialis posterior tendon transfer subcutaneously (TMAR) could be avoided if the transfer is routed under the retinaculum, without significant compromise of the final function and even with a possible better ankle range of motion.
Collapse
Affiliation(s)
- Emilio Wagner
- 1 Foot and Ankle Surgeon, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Pablo Wagner
- 1 Foot and Ankle Surgeon, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
- 2 Hospital Militar de Santiago-Universidad de los Andes, Santiago, Chile
| | - Diego Zanolli
- 1 Foot and Ankle Surgeon, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
- 2 Hospital Militar de Santiago-Universidad de los Andes, Santiago, Chile
| | - Rubén Radkievich
- 1 Foot and Ankle Surgeon, Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Gunther Redenz
- 3 Laboratorio LIBFE, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| | - Rodrigo Guzman
- 3 Laboratorio LIBFE, Escuela de Kinesiología, Facultad de Medicina, Universidad de los Andes, Santiago, Chile
| |
Collapse
|
16
|
Hohenberger GM, Schwarz AM, Weiglein AH, Krassnig R, Kuchling S, Plecko M. Prevalence of the distal oblique bundle of the interosseous membrane of the forearm: an anatomical study. J Hand Surg Eur Vol 2018; 43:426-430. [PMID: 28870130 DOI: 10.1177/1753193417727138] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A study was undertaken to examine the presence of the distal oblique bundle of the forearm in a large sample in order to describe its true prevalence. The study sample consisted of 200 cadaveric forearms. Fifteen were excluded due to defects in the distal interosseous membrane. In the remaining 185 specimens, the distal interosseous membrane was examined following removal of soft tissue, to determine whether a distal oblique bundle was present and whether there were connecting fibres to the distal radio-ulnar joint. The distal oblique bundle was observed in 53 specimens (29%). In 45 of these forearms (85%), one or more connecting fibres to the distal radio-ulnar joint were identified. The presence of a distal oblique bundle in 29% is less frequent than that reported in previous literature. The presence of the distal oblique bundle should be noted and may be of importance in the management of disorders of the distal radio-ulnar joint.
Collapse
Affiliation(s)
| | | | | | - Renate Krassnig
- 1 Department of Orthopedics and Trauma Surgery, Medical University of Graz, Graz, Austria
| | - Sabine Kuchling
- 4 Department for Traumatology, State Hospital Wolfsberg, Wolfsberg, Austria
| | | |
Collapse
|
17
|
Werner FW, LeVasseur MR, Harley BJ, Anderson A. Role of the Interosseous Membrane in Preventing Distal Radioulnar Gapping. J Wrist Surg 2017; 6:97-101. [PMID: 28428910 PMCID: PMC5397305 DOI: 10.1055/s-0036-1584545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
Abstract
Background Damage to the interosseous membrane (IOM) can alter load transmission between the radius and ulna and decrease their axial stability. Less is known about the effect of IOM sectioning on the transverse stability between the radius and ulna. Purpose The purpose of this study was to quantify the radioulnar gapping at the distal radioulnar joint (DRUJ) during forearm rotation when the IOM was experimentally sectioned while maintaining the integrity of the distal radioulnar ligaments. Methods In 12 fresh-frozen cadaver forearms tested in a combined wrist-forearm simulator, the increase in gap between the radius and ulna, at the level of the DRUJ, was determined during cyclic forearm rotation following IOM sectioning. Results IOM sectioning caused a significant increase in dorsal gapping at the DRUJ by 2.1 mm in supination and 0.6 mm in pronation. It also caused an increase in palmar gapping by 1.3 mm in supination and 0.5 mm in pronation. Conclusion This experiment has shown that the IOM has an important role in stabilizing the DRUJ, especially in supination, and that IOM sectioning caused greater loads on the palmar and dorsal radioulnar ligaments. Since DRUJ instability is primarily treated by fixing the laxity at the dorsal radioulnar ligament (DRUL) and palmar radioulnar ligament (PRUL), untreated IOM damage could permit additional injury and instability to the radioulnar ligaments or their reconstruction. Clinical Relevance Reconstruction of a torn IOM should be considered in the presence of persistent DRUJ instability following DRUJ reconstruction.
Collapse
Affiliation(s)
- Frederick W. Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Matthew R. LeVasseur
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Brian J. Harley
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| | - Ashley Anderson
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
| |
Collapse
|
18
|
Hackl M, Andermahr J, Staat M, Bremer I, Borggrefe J, Prescher A, Müller LP, Wegmann K. Suture button reconstruction of the central band of the interosseous membrane in Essex-Lopresti lesions: a comparative biomechanical investigation. J Hand Surg Eur Vol 2017; 42:370-376. [PMID: 27573130 DOI: 10.1177/1753193416665943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Surgical reconstruction of the interosseous membrane may restore longitudinal forearm stability in Essex-Lopresti lesions. This study aimed to compare the longitudinal stability of the intact forearm with a single-bundle and a double-bundle reconstruction of the central band of the interosseous membrane using digital image correlation with a three-dimensional camera system. Single and cyclic axial loading of eight fresh-frozen forearm specimens was carried out in the intact state, after creation of an Essex-Lopresti lesion, after a single-bundle and after a double-bundle reconstruction of the central band using a TightRope® (Arthrex GmbH, Munich, Germany) construct. Instability significantly increased after creation of an Essex-Lopresti lesion. The stability of intact specimens was similar to both reconstruction techniques. The results of this study suggest that TightRope® reconstruction of the central band restores longitudinal forearm stability. However, the single-bundle technique may be less reliable than double-bundle reconstruction. LEVEL OF EVIDENCE Basic Science Study.
Collapse
Affiliation(s)
- M Hackl
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - J Andermahr
- 3 Department of Orthopedic and Trauma Surgery, Hospital of the University of Bonn, Bonn, Germany
| | - M Staat
- 4 Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - I Bremer
- 3 Department of Orthopedic and Trauma Surgery, Hospital of the University of Bonn, Bonn, Germany
| | - J Borggrefe
- 5 Department of Radiology, University Medical Center of Cologne, Cologne, Germany
| | - A Prescher
- 6 Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH-Aachen, Aachen, Germany
| | - L P Müller
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - K Wegmann
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| |
Collapse
|
19
|
Bissuel T, Gaillard F, Dagneaux L, Canovas F. Maisonneuve Equivalent Injury With Proximal Tibiofibular Joint Dislocation: Case Report and Literature Review. J Foot Ankle Surg 2017; 56:404-407. [PMID: 28117256 DOI: 10.1053/j.jfas.2016.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 02/03/2023]
Abstract
We report the case of a 31-year-old male who presented with traumatic dislocation of both proximal and distal tibiofibular joints without fibular fracture. The patient underwent closed reduction of the proximal tibiofibular joint and surgical stabilization of the distal tibiofibular joint. An 18-month postoperative evaluation confirmed a very good clinical outcome after anatomic reduction. This type of trauma is very rare and, to our knowledge, has only been described 3 times previously. Furthermore, our surgical management was different from that used for the previous cases and proved to be satisfactory.
Collapse
Affiliation(s)
- Timothée Bissuel
- Orthopaedic Surgeon, Division of Lower Limb Surgery, Department of Orthopaedic Surgery, University Hospital of Montpellier, Montpellier, France.
| | - Florent Gaillard
- Orthopaedic Surgeon, Division of Lower Limb Surgery, Department of Orthopaedic Surgery, University Hospital of Montpellier, Montpellier, France
| | - Louis Dagneaux
- Orthopaedic Surgeon, Division of Lower Limb Surgery, Department of Orthopaedic Surgery, University Hospital of Montpellier, Montpellier, France
| | - François Canovas
- Professor of Orthopaedic Surgery, Division of Lower Limb Surgery, Department of Orthopaedic Surgery, University Hospital of Montpellier, France
| |
Collapse
|
20
|
Abstract
BACKGROUND 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. PURPOSE The purpose of this review article is to evaluate the dignosis, biomechanics, clinical results, and propose a treatment approach to this rare complex entity. METHODS 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.). RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Robert Matthias
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
| | - Thomas W. Wright
- Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
| |
Collapse
|
21
|
Abstract
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.
Collapse
Affiliation(s)
- Andrew P. Matson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - David S. Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| |
Collapse
|
22
|
Abstract
BACKGROUND Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform. How this method compares to its alternatives, however, is unknown. MATERIALS AND METHODS We review literature describing reconstruction of the forearm axis. We describe how we perform suture-button reconstruction of the IOM, summarize our previously published biomechanical data on the subject, and offer a case report. DESCRIPTION OF TECHNIQUE A suture-button is implanted so as to approximate the course of the interosseous ligament. This may be accomplished percutaneously, or when grafting is desired, through an open approach. RESULTS Data informing the choice of one reconstruction technique over another consist mostly of biomechanical studies and a small number of case reports. CONCLUSIONS Suture-button reconstruction of the IOM may encourage anatomic healing of acute forearm axis injuries especially as an adjunct to radial head replacement or repair. Chronic injuries may benefit from a combination suture-button graft construct and ulnar shortening osteotomy.
Collapse
Affiliation(s)
- Clifton G. Meals
- The Curtis National Hand Center at The MedStar Union Memorial Hospital, Baltimore, Maryland
| | | | - Keith A. Segalman
- The Curtis National Hand Center at The MedStar Union Memorial Hospital, Baltimore, Maryland
| |
Collapse
|
23
|
Anderson A, Werner FW, Tucci ER, Harley BJ. Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head. J Shoulder Elbow Surg 2015; 24:1926-33. [PMID: 26190665 DOI: 10.1016/j.jse.2015.05.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/24/2015] [Accepted: 05/04/2015] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of our study was to determine the relative contributions of the annular ligament, proximal band, central band, and distal band of the interosseous membrane in preventing dislocation of the proximal radius. METHODS In part 1 of the study, 8 forearms were loaded transversely with the forearm intact, and the central band, proximal band, and annular ligament were sequentially sectioned to determine the percentage contribution of each structure in preventing transverse radial displacement. In part 2, 12 forearms were cyclically supinated and pronated while optical sensors measured radial and ulnar motion. Transverse radial head motion was computed as the distal band, central band, and proximal band (and annular ligament) were sequentially sectioned. RESULTS In part 1, there was no significant difference in the percentage contribution of each structure in preventing radial transverse displacement. In part 2, only after sectioning of the central band did significant radial head displacement occur. Greater displacements occurred in supination than in pronation. Dislocation of the proximal radius occurred in 2 arms after sectioning of all 3 structures. DISCUSSION Under pure transverse displacement, the central band, annular ligament, and proximal band equally contributed to stabilizing the radius. However, during forearm rotation, the central band contributed more to radial head stability than the annular ligament and proximal band. Our study contributes to our knowledge of forearm biomechanics, demonstrating the importance of the central band in providing proximal radial head stability. Forceful supination should be avoided after surgical procedures designed to stabilize the radial head.
Collapse
Affiliation(s)
- Ashley Anderson
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Frederick W Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Emily R Tucci
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Brian J Harley
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
24
|
Kachooei AR, Rivlin M, Shojaie B, van Dijk CN, Mudgal C. Intraoperative Technique for Evaluation of the Interosseous Ligament of the Forearm. J Hand Surg Am 2015; 40:2372-6.e1. [PMID: 26547797 DOI: 10.1016/j.jhsa.2015.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To introduce a technique for the diagnosis of interosseous ligament (IOL) disruption based on lateral displacement of the radius after radial head resection and to determine the cutoff value of the lateral displacement for the diagnosis of disruption, the best elbow position for testing, and the diagnostic performance of the technique in different positions. METHODS We used 10 fresh-frozen cadavers. After resection of the radial head, a Steinman pin was placed into the radius medullary canal and used to mark the pin location on the capitellum. We applied 1 kg force to pull the proximal radius laterally and measured the displacement in full supination, neutral, and full pronation of the forearm with the elbow in extension and then in 90° flexion. All measurements were performed once with the IOL intact and again with it cut. To assess diagnostic efficacy, receiver operating characteristics curves were constructed. To determine the quality of the technique, we measured the area under the receiver operating characteristics curve for each position. We also determined the cutoff value to obtain the highest sensitivity and specificity. RESULTS The area under the curve of the test in extension-supination and flexion-supination showed that these positions were excellent for the diagnosis of IOL disruption. The cutoff value of 5.5 mm lateral displacement in extension-supination had 100% sensitivity and 90% specificity. In flexion-supination, the cutoff value of 9 mm had 100% sensitivity and 90% specificity for the diagnosis of IOL disruption. CONCLUSIONS This maneuver was reliable and accurate in cadavers with complete IOL disruption. It is likely that in an intraoperative setting, these results will be reproducible. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
Collapse
|
25
|
Kachooei AR, Rivlin M, Wu F, Faghfouri A, Eberlin KR, Ring D. Intraoperative Physical Examination for Diagnosis of Interosseous Ligament Rupture-Cadaveric Study. J Hand Surg Am 2015; 40:1785-90.e1. [PMID: 26231483 DOI: 10.1016/j.jhsa.2015.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the intraobserver and interobserver reliability of the diagnosis of interosseous ligament (IOL) rupture in a cadaver model. METHODS On 12 fresh frozen cadavers, radial heads were cut using an identical incision and osteotomy. After randomization, the soft tissues of the limbs were divided into 4 groups: both IOL and triangular fibrocartilage (TFCC) intact; IOL disruption but TFCC intact; both IOL and TFCC divided; and IOL intact but TFCC divided. All incisions had identical suturing. After standard instruction and demonstration of radius pull-push and radius lateral pull tests, 10 physician evaluators with different levels of experience examined the cadaver limbs in a standardized way (elbow at 90° with the forearm held in both supination and pronation) and were asked to classify them into one of the 4 groups. Next, the same examiners were asked to re-examine the limbs after randomly changing the order of examination. RESULTS The interobserver reliability of agreement for the diagnosis of IOL injury (groups 2 and 3) was fair in both rounds of examination and the intraobserver reliability was moderate. The intra- and interobserver reliabilities of agreement for the 4 groups of injuries among the examiners were fair in both rounds of examination. The sensitivity, specificity, accuracy, positive, and negative predictive values were all around 70%. The likelihood of a positive test corresponding with the presence of IOL rupture (positive likelihood ratio) was 2.2. The likelihood of a negative test correctly diagnosing an intact IOL was 0.40. CONCLUSIONS In cadavers, intraoperative tests had fair reliability and 70% accuracy for the diagnosis of IOL rupture using the push-pull and lateral pull maneuvers. The level of experience did not have any effect on the correct diagnosis of intact versus disrupted IOL. CLINICAL RELEVANCE Although not common, some failure of surgeries for traumatic elbow fracture-dislocations is because of failure in timely diagnosis of IOL disruption.
Collapse
Affiliation(s)
- Amir Reza Kachooei
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Michael Rivlin
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Fei Wu
- Department of Orthopedic Surgery, Renmin Hospital of Wuhan University, Wuhan City, China
| | - Aram Faghfouri
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kyle R Eberlin
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David Ring
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
| |
Collapse
|
26
|
Malone PSC, Cooley J, Morris J, Terenghi G, Lees VC. The biomechanical and functional relationships of the proximal radioulnar joint, distal radioulnar joint, and interosseous ligament. J Hand Surg Eur Vol 2015; 40:485-93. [PMID: 24835480 DOI: 10.1177/1753193414532807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
Abstract
This biomechanical study assessed integrated function of the proximal radioulnar joint (PRUJ), interosseous ligament (IOL), and distal radioulnar joint (DRUJ). Tekscan™ pressure sensors were inserted into the DRUJ and PRUJ of 15 cadaveric specimens. MicroStrain(®) sensors were mounted onto the IOL on nine of these specimens. A customized biomechanical jig was used to apply axial loads and take measurements through pronosupination. The PRUJ, IOL, and DRUJ were shown to function as an integrated osseoligamentous system distributing applied load. The PRUJ has transmitted pressure profiles similar to those of the DRUJ. Different IOL components support loading at different stages of pronosupination. The IOL is lax during pronation. Mid-IOL tension peaks in the midrange of forearm rotation; distal-IOL tension peaks in supination. Axial loading consistently increases IOL strain in a non-linear fashion. There are clinical implications of this work: disease or surgical modification of any of these structures may compromise normal biomechanics and function.
Collapse
Affiliation(s)
- P S C Malone
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - J Cooley
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - J Morris
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - G Terenghi
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - V C Lees
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| |
Collapse
|
27
|
Thiagarajan G, Lu Y, Dallas M, Johnson ML. Experimental and finite element analysis of dynamic loading of the mouse forearm. J Orthop Res 2014; 32:1580-8. [PMID: 25196694 PMCID: PMC4356248 DOI: 10.1002/jor.22720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/22/2014] [Indexed: 02/04/2023]
Abstract
Bone formation is reported to initiate in osteocytes by mechanotransduction due to dynamic loading of bone. The first step towards this is to characterize the dynamic strain fields in the overall bone. Here, the previously developed mouse forearm ulna-radius model, subjected to static loading, has been further enhanced by incorporating a loading cap and applying a cyclic dynamic load to more closely approximate experimental biological conditions. This study also incorporates data obtained from strain gauging both the ulna and radius simultaneously. Based on separate experiments, the elastic modulus of the ulna and radius were determined to be 13.8 and 9.9 GPa, respectively. Another novel aspect of the numerical model is the inclusion of the interosseous membrane in the FE model with membrane stiffness ranging from 5-15 N/mm that have been found to give strain values closer to that from the experiments. Interestingly, the inclusion of the interosseous membrane helped to equalize the peak strain magnitudes in the ulna and radius (∼1800 at 2 N load and ∼3200 at 3.5 N), which was also observed experimentally. This model represents a significant advance towards being able to simulate through FE analysis the strain fields generated in vivo upon mechanical loading of the mouse forearm.
Collapse
Affiliation(s)
- Ganesh Thiagarajan
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 350L Flarsheim Hall, 5100 Rockhill Road, Kansas City, Missouri 64110
| | - Yunkai Lu
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 350L Flarsheim Hall, 5100 Rockhill Road, Kansas City, Missouri 64110
| | - Mark Dallas
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Room 3143, 650 E 25th Street, Kansas City, Missouri 64108
| | - Mark L. Johnson
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Room 3143, 650 E 25th Street, Kansas City, Missouri 64108
| |
Collapse
|
28
|
Abstract
It has been reported that the distal interosseous membrane (DIOM) of the forearm constrains the dorsal dislocation of the distal radius. A residual ulnar translation deformity of the radial shaft in distal radius fractures has the potential to cause distal radioulnar joint (DRUJ) instability when triangular fibrocartilage complex (TFCC) injury is also present, because it may result in detensioning of the DIOM. Correction of ulnar translation of the radial shaft is critical because it restores DIOM tension, which then firmly holds the ulnar head in the concavity of the sigmoid notch.
Collapse
Affiliation(s)
- Hisao Moritomo
- Osaka Yukioka College of Health Science, Yukioka Hospital Hand Center, Osaka, Japan
| | - Shinsuke Omori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
29
|
Abstract
Forearm instability results from trauma, which disrupts the radial head, the interosseous membrane, and the triangular fibrocartilage complex. Inadequate treatment of injuries to these forearm stabilizers may result in the complex problem of chronic longitudinal forearm instability. Delayed recognition and/or treatment of injuries producing forearm dissociation has led to poor patient outcomes, which makes timely recognition of the injury pattern imperative. This article discusses relevant aspects of forearm anatomy and current concepts in the diagnosis and treatment options for this complex injury pattern.
Collapse
Affiliation(s)
| | | | - David S Zelouf
- Philadelphia Hand Center, King of Prussia, Pennsylvania.
| |
Collapse
|