The Biomechanical Effect of the Distal Interosseous Membrane on Distal Radioulnar Joint Stability: A Preliminary Anatomic Study

doi:10.1016/j.jhsa.2011.07.016

The Journal of Hand Surgery

Volume 36, Issue 10, October 2011, Pages 1626-1630

https://doi.org/10.1016/j.jhsa.2011.07.016 Get rights and content

Purpose

The distal interosseous membrane (DIOM) is a secondary stabilizer of the distal radioulnar joint (DRUJ) and has a considerably variable morphology. The purpose of this study was to investigate whether innate DRUJ stability is influenced by the anatomic variation of the DIOM.

Methods

Ten fresh-frozen cadaver upper extremities were used in this study. The humerus and the ulna were affixed rigidly to a custom-made apparatus, with the elbow in 90° of flexion. Testing was performed by translating the radius in volar and dorsal directions relative to the ulna, with a 20-N applied force in neutral forearm alignment, 60° pronation, and 60° supination. Total translation of the radius was measured as DRUJ laxity. After the experiment, we investigated anatomic variation of the DIOM, especially regarding the existence of the distal oblique bundle (DOB), which is a notably thick fiber within the DIOM. We compared the DRUJ stability between the groups with and without the DOB.

Results

The DOB was found in 4 of 10 specimens. The group with a DOB demonstrated a significantly greater DRUJ stability in the neutral position than the group without a DOB. In pronated and supinated forearm positions, no significant difference in DRUJ stability was obtained between the groups with and without a DOB.

Conclusions

Innate DRUJ stability in the neutral forearm position was greater in the group with a DOB than in those without a DOB.

Clinical relevance

This study suggests that considerable variation exists in DRUJ laxity and that it partially depends on anatomical variations of the DIOM.

Section snippets

Specimen preparation

Ten fresh-frozen cadaver upper extremities (5 male, 5 female), amputated at the mid-portion of the humerus, were used for this study. The ages ranged from 59 to 91 years (mean, 79 y). There was no history of wrist or forearm trauma or disease in any of the specimens. All specimens were evaluated radiographically, and we rejected any specimens with evidence of instability or articular pathology. The specimen's ulnar variance was also assessed using posteroanterior radiographs. Six cases were

Biomechanical analysis

The average DRUJ laxity (mean ± SD) of the 10 specimens was 18.8 ± 5.4 mm in the neutral position, 14.3 ± 4.1 mm in pronation, and 16.0 ± 4.1 mm in supination. Average DRUJ laxity (mean ± SD) in the group with a DOB (n = 4) was 14.8 ± 4.4 mm in neutral position, 11.9 ± 5.2 mm in pronation, and 13.3 ± 4.5 mm in supination. The group with a DOB showed a significantly greater DRUJ stability in the neutral position than the group without a DOB (P < .05) (Fig. 2). In the pronated and supinated

Discussion

We found in this study that the degree of displacement of the radius relative to the ulna was smaller in the group with a DOB than without a DOB in the neutral forearm position, which suggests that DRUJ laxity was greater in the group without a DOB than with a DOB. The TFCC is the primary soft-tissue DRUJ stabilizer and, in normal situations, the influence of the DIOM on the DRUJ stability is relatively inconsequential. However, after TFCC injury or ulnar head resection, it is likely that the

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The Contribution of the Distal Oblique Band to Distal Radioulnar Joint Stability
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The distal radioulnar joint (DRUJ) is supported by an array of dynamic and static stabilizers, of which the triangular fibrocartilage complex (TFCC) is the most important, and the distal interosseous ligament is next in importance. The distal oblique band (DOB) is an identifiable component of the distal interosseous ligament, found in a subset of the population. Our objective was to determine the contribution of the DOB to DRUJ stability in the presence of a disrupted TFCC.
Twenty-three above-elbow specimens were prepared by removing the TFCC and the DRUJ joint capsule, preserving the distal interosseous ligament and the pronator quadratus. Cadavers were stratified into two groups—those with, and those without a DOB. A bone plate and screws were attached to the ulna; then, a transverse load was applied to failure, creating a diastasis between the radius and ulna.
The group with a DOB had a mean load at failure of 160.7 ± 46.5 N. The group without a DOB had a mean load at failure of 148.0 ± 26.3 N. Stiffness prior to failure was 16.9 N/mm in the group with a DOB and 12.4 N/mm in the group without a DOB.
The current results indicate that the DOB may not substantially contribute to DRUJ stability in the presence of a disrupted TFCC.
Stability of the DRUJ after TFCC injury may not be substantially improved by the presence of a DOB. Thus, the clinical importance of DOB reconstruction remains unclear.
Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation
2023, Journal of Hand Surgery Global Online
The purpose of this study was to measure distal radioulnar joint (DRUJ) dislocation and radioulnar displacement associated with sequential sectioning of the different bands of the interosseous membrane and triangular fibrocartilage complex in the simulation of a Galeazzi fracture dislocation.
Twelve fresh-frozen cadaver forearms were dissected. We examined the anatomy and function of the forearm interosseous membrane. Each forearm was then mounted onto a biomechanical wrist and forearm device. In the control group, radial osteotomy was performed and the degree of DRUJ displacement with progressive loads was measured. In addition to radial osteotomy, in group 1, the central band (CB) was sectioned; in group 2, the CB, distal membranous portion of the interosseous membrane, and distal oblique bundle were sectioned; and in group 3, the CB, distal membranous portion of the interosseous membrane, distal oblique bundle, and triangular fibrocartilage complex were sectioned.
The radioulnar displacement (mm) at 25 N, 50 N, and 75 N was recorded. In group 1, applying progressive loads resulted in an average DRUJ displacement of 4.3, 5.9, and 7.9 mm, respectively. In group 2, the displacement was 5.2, 5.7, and 6.9 mm, respectively. In group 3, the displacement was 6.2, 8.1, and 9.9 mm, respectively. Our study showed a correlation between increase in the load applied to the same injury and the degree of displacement (P = .001). In group 3, the degree of DRUJ displacement was statistically increased compared to the other groups (P = .04).
Migration of the radius under loads implies disruption of both the CB and triangular fibrocartilage complex. The distal oblique bundle by itself does not seem to have a relevant role in radioulnar displacement at the DRUJ.
This study provides insights into the interosseous membrane and stability of the DRUJ, which can contribute to a better understanding of Galeazzi fracture-dislocations.
Does surgical reconstruction of the distal oblique bundle (DOB) provide similar stability as the intact bundle or Adams procedure? A systematic review
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The aim of this review was to summarize the available evidence for biomechanical stability following surgical DOB reconstruction, and to determine whether distal radioulnar joint (DRUJ) stability with a reconstructed DOB was similar to the native intact condition or that after the Adams procedure.
A systematic literature search according to the PRISMA guidelines was performed using the databases PubMed and Embase. The following search algorithm was used: (“DOB” OR “Distal Oblique Bundle”) AND “Reconstruction”. Biomechanical or human cadaveric studies that measured stability of the DRUJ after reconstruction of the DOB were included.
Four articles were included in the final analysis. DOB incidence was reported to be between 50% and 70%. Two studies observed no differences between the intact situation and the reconstructed DOB, respectively the Adams procedure. A further author group found no signs of major instability after the Adams reconstruction or after DOB reconstruction, except for decreased stability during supination in the DOB sample. In another study, similar results could be shown for the Adams and DOB reconstruction groups; however, the DOB sample showed decreased dorsal translation of the radius during forearm supination.
In conclusion, DOB reconstruction was proven to stabilize the DRUJ adequately. Moreover, the reconstructed DOB showed the same stability as the native DOB, except for one study, in which stability following reconstruction was reduced during supination. No significant difference between the DOB and the Adams reconstruction could be observed.
Unstable lesions of the forearm: Terminology, evaluative score and synoptic table
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The term “unstable lesions of the forearm” (ULF) was born to more easily describe how a partial or complete instability of the forearm unit might occur due to a traumatic loss of the transverse or longitudinal connection between the radius and ulna. For such an alteration to occur, at least two of the three main osteoligamentous locks (proximal, middle and distal) must be interrupted, often in association with a radial and/or ulnar fracture. Examining the historical patterns (Monteggia, Galeazzi, Essex–Lopresti and criss-cross lesions) and variants described in the literature, out of a total of 586 recorded interventions for forearm trauma, two elbow teams and one wrist team selected 75 cases of ULF. The aim was to describe the instability depending on its clinical and radiographic features, together with the anatomopathological evolution of the lesions based on the time of diagnosis and treatment. The clinical results, evaluated using a new score (FIPS) the Forearm Italian Performance, revealed a correlation between earlier diagnosis and treatment and a better score. The authors suggest a synoptic table that describes 1) the type of instability (proximal transverse, distal transverse, longitudinal and transverse, proximal and distal transverse), 2) classic patterns and variants with characteristic lesions and evolution over time (acute, chronic dynamic, chronic static) and 3) the three forearm constraints and segmental involvement of radius and/or ulna using an alphanumeric classification. Finally, some generic surgical suggestions are proposed.
Distal radioulnar joint instability: Diagnosis and treatment of acute and chronic lesions
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Distal radioulnar joint instability is a common clinical condition that can be either acute or chronic. Its management requires extensive knowledge of all the anatomical structures around the wrist area. The clinical examination must identify all damaged structures in order to define a customized reconstruction strategy. The aim of treatment is to prevent the development of chronic instability and/or arthritic lesions, which can only be treated with palliative surgery. Distal radioulnar instability is complex. Its management shares similarities with that of knee instability, with a wide range of conditions ranging from a sprain with isolated ligament tear to complex dislocation in which multiple ligaments are torn. In particular, the triangular fibrocartilage complex, which is a pillar of distal radioulnar joint stability, is not the sole stabilizer of this joint. The treatment strategy is not as simple as just reattaching this ligament to treat all of the acute and chronic clinical signs. The goal of the present study is to describe the various structures and possible lesions in this joint and then how to repair them. The diagnostic and therapeutic difficulties justify treatment at a specialized center.

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: All work performed at Mayo Clinic Rochester.

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Scientific articleThe Biomechanical Effect of the Distal Interosseous Membrane on Distal Radioulnar Joint Stability: A Preliminary Anatomic Study

Purpose

Methods

Results

Conclusions

Clinical relevance

Section snippets

Specimen preparation

Biomechanical analysis

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Scientific article
The Biomechanical Effect of the Distal Interosseous Membrane on Distal Radioulnar Joint Stability: A Preliminary Anatomic Study