Forearm Interosseous Membrane Maintains the Stability of Proximal Radioulnar Joint.

OBJECTIVE: To evaluate the effect of the proximal and central bundles of the interosseous membrane on the stability of proximal radioulnar joint. METHODS: Twenty fresh samples of human forearm provided by the anatomy room of the Department of Human Anatomy of Nanjing Medical University were included in this study. They were used to explore the effect of proximal interosseous membrane bundle on the stability of proximal radioulnar joint. The proximal bundle was reconstructed along the original attachment point. The reconstructions of central bundle were divided into the reconstruction of original attachment point on radius-midpoint of the ulnar original attachment point (reconstruction A) and original attachment point reconstruction (reconstruction B). The loads of the proximal radioulnar joint in different positions were measured. The load of the proximal radioulnar joint was analyzed in neutral, pronation, and supination positions. RESULTS: After resection of proximal and central fascicles, the loads of proximal radioulnar joint in neutral, pronation, and supination positions were significantly lower than those before resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05), and that after reconstruction B in pronation position was higher than that after resection (P < 0.05), while there was no significant difference between reconstruction A and after resection (P > 0.05). In supination position, the load of reconstruction B was higher than that of reconstruction A (P < 0.05). After reconstruction of the proximal and central bundles, the proximal radioulnar joint could not reached the same load as it could before resection (P < 0.05). CONCLUSION: The stability of proximal radioulnar joint is affected by central bundle and proximal bundle. Reconstruction can increase the stability of proximal radioulnar joint.

The Essex-Lopresti Injury:: Evaluation and Treatment Considerations.

This article describes evaluation and treatment considerations for Essex-Lopresti injuries. Specific information about pattern recognition and treatment options is provided.

Diagnosis and treatment of ankle syndesmosis injuries with associated interosseous membrane injury: a current concept review.

BACKGROUND: Tibiofibular syndesmosis injury leads to ankle pain and dysfunction when ankle injuries are not treated properly. Despite several studies having been performed, many questions about diagnosis and treatment remain unanswered, especially in ankle syndesmosis injury with interosseous membrane injury. Therefore, the purpose of this study was to help guide best practice recommendations. METHODS: This review explores the mechanism of injury, clinical features, diagnosis methods, and the treatment strategy for ankle syndesmosis injury with interosseous membrane injury to highlight the current evidence in terms of the controversies surrounding the management of these injuries. RESULTS: Radiological and CT examination are an important basis for diagnosing ankle syndesmosis injury. Physical examination combined with MRI to determine the damage to the interosseous membrane is significant in guiding the treatment of ankle syndesmosis injury with interosseous membrane injury. In the past, inserting syndesmosis screws was the gold standard for treating ankle syndesmosis injury. However, there were increasingly more controversies regarding loss of reduction and broken nails, so elastic fixation has become more popular in recent years. CONCLUSIONS: Anatomical reduction and effective fixation are the main aspects to be considered in the treatment of ankle syndesmosis injury with interosseous membrane injury and are the key to reducing postsurgery complications.

Interosseous Membrane Reconstruction Utilizing Flexor Digitorum Superficialis Autograft.

Interosseous membrane (IOM) deficiency results in longitudinal radioulnar instability, and may result in proximal radial migration, increased radiocapitellar contact, limitations in forearm rotation, ulnocarpal instability, and ulna-sided pain. A number of reconstruction methods have been posited-however, few have been implemented in vivo. We describe a 2-bundle method of IOM reconstruction, utilizing flexor digitorum superficialis autograft. This technique has the benefits of utilizing a locally available and robust autograft with minimal donor-site morbidity, obviating the concerns associated with synthetic grafts or bone-patella tendon-bone constructs. It also replicates the nonisometric nature of the native IOM. We also present long-term results of a patient who underwent IOM reconstruction utilizing this method, following a cadaveric feasibility study.