Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure

Abstract

Total longitudinal disruptions of the interosseous membrane can allow proximal radius migration and are seen in Essex-Lopresti lesions. We propose an original technique of ligamentoplasty using the semitendinosus tendon. The graft corresponds to the forearm rotation axis for an optimized isometry and longitudinal stabilization. Our ligamentoplasty technique was performed on ten fresh frozen right forearms. We successively assessed the innocuousness, efficiency and resistance of the ligamentoplasty. The ligamentoplasty induced neither passive limitation of pronation-supination nor neurovascular lesions. It prevented from radius proximal migration. The mean load to failure was 28 kg at both ulnar and radial sides of the graft. Our technique is original for the type and position of the graft. It seems safe, efficient and resistant enough for in vivo procedures. This technique decreases longitudinal loads on the radius. It should be indicated in patients with Essex-Lopresti syndrome, in association with radial head internal fixation or arthroplasty.

Essex-Lopresti lesion associated with an impacted radial neck fracture: interest of ulnar shortening in the secondary management of sequelae

“…To determine the integrity of the interosseous membrane and congruency of the DRUJ ultrasound, CT and magnetic resonance imaging have been shown to be useful and might be considered in high-energy injuries or in patients with wrist or forearm tenderness and ecchymosis. 1,16,[20][21][22]27 We identified 3 reported patients with an Essex-Lopresti lesion associated with a radial neck fracture. 18 RodriguezMartin et al 18 recently described an Essex-Lopresti injury with a radial neck fracture and interosseous ligament injury but normal wrist radiographs.…”

Comminuted radial head fractures: aspects of current management

“…58,81 Several reconstruction methods have been described involving autologous tendons. 9,67,78,80 Nevertheless, restoration of the interosseous membrane is a much more demanding procedure compared with isolated radial head reconstruction, and clinical evidence to support its routine use is lacking. Hence, we do not routinely address the interosseous membrane in the acute scenario, recommending exploration only if persistent instability exists after radial head reconstruction.…”

Wrist denervation of the posterior interosseous nerve through a volar approach: a new technique with anatomical considerations

“…Visualization may be difficult when the muscle is of poor quality, shredded through trauma or retracted and fibrous due to previous denervation when performing distal radius fixation using a volar locking plate [14]. Anyway, with the additional measurements from the radial styloid the transection might be possible even in event that the pronator quadratus cannot be used as a landmark.…”