An anatomical and biomechanical assessment of the interosseous membrane of the cadaveric forearm

Razak, Hamid Rahmatullah Bin Abd; Yew, Khye-Soon Andy; Moideen, Irwan Shah Bin Mohd; Tay, Xian-Khing Kenny; Howe, Tet-Sen; Koh, Suang-Bee Joyce

doi:10.1177/1753193419900490

Cited by 11 publications

(12 citation statements)

References 26 publications

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“…Based on 10 specimens, Bin Abd Razak et al. (2020) described that IOMs consisted of five entities: the CB, accessory bundle, distal oblique bundle, proximal oblique cords and dorsal oblique accessory cords.…”

Section: Discussionmentioning

confidence: 99%

“…The interosseous membrane (IOM) is a forearm stabilizer and has been traditionally described as one major central band (CB) with two oblique bands, one proximal and one distal (Masouros et al., 2019; Skahen et al., 1997). Other studies have described five structures for the IOM: the proximal oblique cord, dorsal oblique accessory cord, CB, accessory band and distal oblique band (Bin Abd Razak et al., 2020; Noda et al., 2009). Reconstruction of the IOM may be necessary following injury, for example, to correct instability encountered with an Essex–Lopresti instability (Skahen et al., 1997; Tejwani et al., 2005; Tomaino et al., 2003).…”

Section: Introductionmentioning

confidence: 99%

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The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands

Kholinne

Kwak

Sun

et al. 2020

J Hand Surg Eur Vol

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We compared the mechanical properties of the three parts of interosseous membranes in 12 fresh-frozen specimens. The proximal, central and distal bands of interosseous membranes were tested in a universal testing machine. Tensile strength, ultimate strain, ultimate load and elastic modulus were measured and compared. The stress–strain relationship curves of these bands were similar to those of ligaments. Tensile strength, ultimate load and elastic modulus were significantly higher in the central band than in the proximal and distal bands. Ultimate strain was significantly lower in the central band than in proximal and distal bands. We conclude that the interosseous membrane is similar to ligaments in structure with each band having distinct characteristics. The findings may aid in clinical choice of proper grafts used for interosseous membrane reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands

Kholinne

Kwak

Sun

et al. 2020

J Hand Surg Eur Vol

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“…Forearm rotation follows the axis directed from the radial head to the ulnar fovea, occurring with full range of motion and physiological stability when forearm bones and soft tissues stabilizers of PRUJ, MRUJ, and DRUJ are preserved [22]. Recent findings have suggested that PRUJ and MRUJ are probably more critical than IOM for forearm rotation, while IOM provides static longitudinal stabilization of the forearm and less so as a rotational stabilizer [23].…”

Section: Discussionmentioning

confidence: 99%

“…Two-locker injuries 1.2I PRUJ dislocation-IOM rupture Rethnam [23], Sharma [24], Obert [25], El Ibrahimi [28], Watanabe [27], Koulali-Idrissi [29] 1.2 IU PRUJ dislocation-IOM rupture-ulna fracture Rehim [5] 1.2IR PRUJ dislocation-IOM rupture-radius fracture Rao [38], Haddad [39], Linzel [40], Mehara [41], Cherif [42], Simpson [45], Shamian [43], Singh [44] 1.2RIU PRUJ dislocation-IOM rupture-ulna fracture-radius fracture Ouakrim [63] 2I.3 IOM rupture-DRUJ dislocation Wassink [30], Szabo [31], Bruckner [32], Carlsen [33] 2IR 1.3 PRUJ dislocation-DRUJ dislocation Leung [9], Verettas [10], Potter [11], Nishi [12], Spicer [13], Papageorgiu [14], Wong [35], Tosun [36], Raghavendra [37] Three-locker injuries [19,41], closed reduction and percutaneous DRUJ pinning [15,18], and open reduction with radial head fixation or ligamentous repair [14,16,17]. In two-locker injuries with ulna and/or radius shaft fracture, forearm bones must undergo osteosynthesis.…”

Section: Type Lesion Description Authorsmentioning

confidence: 99%

Fracture–dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system

et al. 2020

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Background Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture–dislocation of the forearm. Uncommon variants and rare traumatic patterns of forearm fracture–dislocations have sometimes been reported in literature. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts. Methods A comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture–dislocation of the forearm. Essex-Lopresti injury, Monteggia and Galeazzi fracture–dislocations, and proximal and/or distal radioulnar joint dislocations were sought. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1 [including proximal radioulnar joint (PRUJ) dislocation with or without radial head fractures], middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3 [including distal radioulnar joint (DRUJ) dislocation with or without distal radial fractures]. Results Eighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture–dislocation were included. Three historical reviews were added separately to the process. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. In addition to fracture–dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors’ knowledge, allowed us to include all types of dislocation and fracture–dislocation of the forearm joint reported in literature. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture–dislocations) of the forearm joint. Conclusions All injury patterns may be previously identified using an alphanumeric code. This might avoid confusion in forearm fracture–dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment. Level of evidence V.

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“…The accessory bands are distinct structures that are more distal and less substantial than the CB. They vary in number and are differentiated from the CB by thickness more than visual appearance 2-4 (Fig. 1-B).…”

Section: Anatomymentioning

confidence: 99%

Essex-Lopresti Lesions and Longitudinal Radioulnar Instability

et al. 2022

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An Essex-Lopresti injury (ELI) is classically described as a radial head fracture with a concomitant interosseous ligament complex (IOC) injury. However, multiple injury patterns may be present, and an interosseous membrane (IOM) injury should be evaluated for in any axial load injury through the forearm. ELI may result in longitudinal radioulnar instability (LRUI).» Diagnosis of an IOC injury can be difficult. Evaluation begins with standard wrist and elbow radiographs and is supplemented with radiographs and intraoperative maneuvers to assess for proximal radial migration. Magnetic resonance imaging and ultrasonography may be useful in the acute setting, although indications and the clinical importance of the findings remain unclear.» Surgical management of an acute ELI is focused on restoration of radial length and temporary distal radioulnar joint (DRUJ) stabilization. Radial head excision in the acute setting should be approached with caution because proximal migration may not be present acutely but may develop over time. The indication for acute IOM repair and reconstruction remains unclear.» Surgical management of a chronic ELI is focused on restoration of radial length, wrist leveling, and treatment of degenerative changes (either at the radiocapitellar joint or the DRUJ). Reconstruction of the central band can restore forearm load transfer and produce favorable functional outcomes, but its indications continue to be debated.

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An anatomical and biomechanical assessment of the interosseous membrane of the cadaveric forearm

Cited by 11 publications

References 26 publications

The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands

The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands

Fracture–dislocations of the forearm joint: a systematic review of the literature and a comprehensive locker-based classification system

Essex-Lopresti Lesions and Longitudinal Radioulnar Instability

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