The Distal Interosseous Membrane: Current Concepts in Wrist Anatomy and Biomechanics
ABSTRACT The distal interosseous membrane (DIOM) of the forearm acts as a secondary stabilizer of the distal radioulnar joint (DRUJ) when the dorsal and palmar radioulnar ligaments of the triangular fibrocartilage complex are cut. Recent anatomical studies revealed that thickness of the DIOM varies widely among specimens and the distal oblique bundle (DOB) exists within the DIOM in 40% of specimens. The DOB originates from the distal one-sixth of the ulnar shaft and runs distally to insert on the inferior rim of the sigmoid notch of the radius. The mean thickness of the DIOM without a DOB was 0.4 mm, which was significantly thinner than 1.2 mm with a DOB. Biomechanical studies have shown that the DOB is an isometric stabilizer of the forearm during pronosupination. The presence of a DOB was shown to have a significant impact on DRUJ stability. Innate DRUJ laxity in the neutral forearm position was greater in the group without a DOB than in the group with a DOB. Ulnar shortening with the osteotomy performed proximal to the attachment of the DIOM had a more favorable effect on stability of the DRUJ compared with the effect of distal osteotomy, especially in the presence of a DOB. The longitudinal resistance to ulnar shortening was significantly greater in proximal shortening than in distal shortening. It also suggested that the DIOM is of great importance in the management of concomitant ulnar-side injuries in distal radius fracture.
- SourceAvailable from: Frédéric Degez[Show abstract] [Hide abstract]
ABSTRACT: El codo y la pronosupinación constituyen una unidad funcional que coloca la mano de forma óptima y automática para la realización de diversas funciones. El codo agrupa el húmero, el cúbito y el radio en una sola articulación que permite la flexión y la extensión de este conjunto, así como la rotación axial del radio. La pronosupinación se basa en la rotación o pivote del radio alrededor del cúbito por efecto de tres estructuras: la articulación radiocubital proximal, la membrana interósea y la articulación radiocubital distal, que al mismo tiempo son potenciales cerrojos para esta acción. Esta unidad funcional se comporta como un cardán que transmite fuerzas con la mano en función de compresión o de tracción y con el hombro estabilizado. Durante la pronosupinación, el codo está expuesto a microtraumatismos, siempre con relación a fuerzas generadas con alta resistencia y a menudo asociadas a la carga. El deporte, las actividades de tiempo libre y las caídas son fuentes de traumatismos de las estructuras articulares y ligamentosas. Cualquier lesión provoca desgaste o un daño a varios niveles que obliga a efectuar una exploración conjunta de la muñeca y el hombro. La complejidad anatómica, la función automática y sus exigencias, sobre todo en términos de duración, y la diversidad de las lesiones impulsan a realizar una exploración física completa y metódica. La anamnesis debe ser bien rigurosa y cotejarse con todos los datos obtenidos mediante la palpación y las pruebas necesarias según los signos de alarma.02/2014; 35(1):1–11. DOI:10.1016/S1293-2965(13)66658-X
- [Show abstract] [Hide abstract]
ABSTRACT: Introduction The Essex-Lopresti injury is characterized by proximal migration of the radius and disruption of theinterosseous membrane. The treatments described for this injury consist of open reduction and internal fixation with osteosynthesis, or replacement of the radius dome plus fixation of distal radioulnar joint. An anatomical reconstruction of the interosseous membrane has been proposed to restore the biomechanical axis of the forearm. The purpose of this study was to define and make measurements of structures comprising the interosseous membrane to obtain anatomical parameters that might help the surgeon to perform a more anatomical surgical reconstruction of this structure. Materials and methods An anatomical dissection was performed on 10 fresh human cadaveric forearms, removing all soft tissue to reveal the interosseous membrane. The presence or absence of interosseous structures was recorded, as well as the length and angulation of their related structures. Results The interosseous membrane consists of a central band, an interosseous proximal band, and a membranous portion; these structures, along with accessory bands were present in all 10 specimens. The central band had an average length in its proximal and distal aspects of 3.3 cm (SD 0.589) and 5.5 cm (SD 1.580), respectively; and an angle of 20.4 degrees of the fibers. Discussion The interosseous membrane is essential for the transfer of compressive forces in the arm. The results are comparable to those reported in other studies. This study provides information about the normal morphology of the interosseous membrane in order to surgically achieve an anatomical reconstruction of it, as well as allowing the surgeon to take into account its different structures.09/2013; 27(3):140–143. DOI:10.1016/S0120-8845(13)70009-9
- [Show abstract] [Hide abstract]
ABSTRACT: Background This study created an anatomic reconstruction of the distal oblique bundle (DOB) of the interosseous membrane to determine its effect on distal radioulnar joint (DRUJ) instability and compare this technique with distal radioulnar ligament (DRUL) reconstruction. Questions/Purposes We hypothesized that this reconstruction would provide equivalent stability to DRUL reconstruction and that combining the two techniques would enhance stability. Methods Six cadaveric upper limbs were affixed to a custom frame. The volar/dorsal translation of the radius relative to the ulna was measured in 60° pronation, neutral, and 60° supination. Translation was sequentially measured with the DRUJ intact, with sectioned DRULs and triangular fibrocartilaginous complex (TFCC), and with sectioned DOBs. Reconstructions were performed on the DRULs, on the DOB tensioned in both neutral and supination, and employing both techniques. Results The DOB reconstruction, tensioned both in the neutral position and in 60° supination, was more stable than the partial and complete instability in 6/6 specimens in pronation and the neutral position and in 5/6 specimens in supination. The DOB reconstruction and the DOB reconstruction tensioned in supination were more stable than the DRUL reconstruction in 4/6 patients. Combining the two techniques did not further reduce translation. Conclusions The DOB reconstruction is capable of improving stability in the unstable DRUJ.11/2013; 2(4):330-6. DOI:10.1055/s-0033-1358546