A biomechanical study on reconstruction of forearm interosseous membrane using extensor carpi radialis longus combined with radial head replacement for restoring forearm longitudinal stability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUOJianbang ¹ ,  ZHAOYouming ² , LIXiaobin ¹ , WUXingguo ¹ , LIUYining ¹

1. Department of Orthopaedics, Traditional Chinese Medicine Hospital of Meizhou City. Meizhou Guangdong, 514000, P. R. China;
2. Department of Orthopaedics, the Second Affiliated Hospital of Wenzhou Medical University;

Corresponding author：

ZHAOYouming, Email: ymzhao710@163.com

Keywords：

Forearm interosseous membrane; Extensor carpi radialis longus; Radial head replacement; Biomechanics

DOI：

10.7507/1002-1892.20160165

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Objective To evaluate the effect of reconstruction of forearm interosseous membrane (IOM) using extensor carpi radialis longus combined with radial head replacement for restoring the forearm longitudinal stability. Methods Ten fresh-frozen adult cadaveric forearms were selected, including 8 males and 2 females with a mean age of 38.2 years (range, 29-74 years). Each forearm was treated as following steps: radial head excision (group A), radial head excision+the distal ulnar radial joints separation (group B), radial head excision+the distal ulnar radial joints separation+IOM central band excision (group C), reconstructed IOM with extensor carpi radialis longus tendon (group D), radial head prothesis replacement (group E), and reconstructed IOM with extensor carpi radialis longus tendon+radial head prothesis replacement (group F). The distance between ulna and radius and radioulnar joint displacement were observed under load and non load. The force loading on both ends of specimen was recorded when the radius shifted 5 mm proximally. Results Restoring the radial length could maintain normal distance between radius and ulna. The interosseous membrance reconstruction could restore the load transmission between radius and ulna. The force loading specimen was (74.507±4.967), (49.227±1.940), (17.827±1.496), (24.561±1.390), (140.247±8.029), and (158.423±9.142)N in groups A, B, C, D, E, and F respectively when the radius shifted 5 mm proximally, showing significant difference among groups (P < 0.01). Conclusion Reconstruction of the IOM with the extensor carpi radialis longus tendon is insufficient to restore the forearm longitudinal stability. Reconstruction using extensor carpi radialis longus tendon combined with radial head replacement may be a new choice for treatment of forearm longitudinal instability.

Citation： GUOJianbang, ZHAOYouming, LIXiaobin, WUXingguo, LIUYining. A biomechanical study on reconstruction of forearm interosseous membrane using extensor carpi radialis longus combined with radial head replacement for restoring forearm longitudinal stability. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 804-808. doi: 10.7507/1002-1892.20160165 Copy

1.	Essex-Loprestipe. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg (Br), 1951, 33B(2): 244-247.
2.	Sabo MT, Watts AC. Reconstructing the interosseous membrane: a technique using synthetic graft and endobuttons. Tech Hand Up Extrem Surg, 2012, 16(4): 187-193.
3.	Adams JE, Osterman MN, Osterman AL. Interosseous membrane reconstruction for forearm longitudinal instability. Tech Hand Up Extrem Surg, 2010, 14(4): 222-225.
4.	Brin YS, Palmanovich E, Bivas A, et al. Treating acute Essex-Lopresti injury with the TightRope device: a case study. Tech Hand Up Extrem Surg, 2014, 18(1): 51-55.
5.	Fomaino MM, Pfaeffle J, Stabile K, et al. Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg (Br), 2003, 28(3): 267-270.
6.	Miller AJ, Naik TU, Seigerman DA, et al. anatomic interosseus membrane reconstruction utilizing the biceps button and screw tenodesis for essex-lopresti injuries.Tech Hand Up Extrem Surg, 2016, 20(1): 6-13.
7.	Tejwani SG, Markolf KL, Benhaim P. Reconstruction of the interosseous membrane of the forearm with a graft substitute: a cadaveric study. J Hand Surg (Am), 2005, 30(2): 326-334.
8.	Tejwani SG, Markolf KL, Benhaim P. Graft reconstruction of the interosseous membrane in conjunction with metallic radial head replacement: a cadaveric study. J Hand Surg (Am), 2005, 30(2): 335-342.
9.	Pfaeffle HJ, Stabile KJ, Li ZM, et al. Reconstruction of the interosseous ligament restores normal forearm compressive load transfer in cadavers. J Hand Surg (Am), 2005, 30(2): 319-325.
10.	Ruch DS, Chang DS, Koman LA. Reconstruction of longitudinal stability of the forearm after disruption of interosseous ligament and radial head excision (Essex-Lopresti lesion). J South Orthop Assoc, 1999, 8(1): 47-52.
11.	Poitevin LA. Anatomy and biomechanics of the interosseous membrane: its importance in the longitudinal stability of the forearm. Hand Clin, 2001, 17(1): 97-110, vii.
12.	Marcotte AL, Osterman AL. Longitudinal radioulnar dissociation: identification and treatment of acute and chronic injuries. Hand Clin, 2007, 23(2): 195-208, vi.
13.	Chloros GD, Wiesler ER, Stabile KJ, et al. Reconstruction of essex-lopresti injury of the forearm: technical note. J Hand Surg (Am), 2008, 33(1): 124-130.
14.	Oberlin C, Belkheyar Z, Soubeyrand M, et al. Semitendinosus ligamentoplasty of the forearm interosseous membrane in a case of Essex-Lopresti syndrome. J Orthop Surg Traumatol, 2006, 16: 164-168.
15.	Soubeyrand M, Oberlin C, Dumontier C, et al. Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure. Surg Radiol Anat, 2006, 28(3): 300-307.
16.	郭建邦, 李武, 黄小敬, 等.旋前圆肌肌腱重建骨间膜中央束对Essex-Lopresti损伤后前臂纵向稳定的作用.中华创伤杂志, 2010, 26(3): 234-237.
17.	Hoshino CM, Tran W, Tiberi JV, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg (Am), 2013, 95(7): 653-659.
18.	Lanting BA, Ferreira LM, Johnson JA, et al. The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. Bone Joint J, 2013, 95-B(10): 1383-1387.
19.	Orbay JL, Mijares MR, Berriz CG. The transverse force experienced by the radial head during axial loading of the forearm: A cadaveric study. Clin Biomech (Bristol, Avon), 2016, 31: 117-122.

1. Essex-Loprestipe. Fractures of the radial head with distal radio-ulnar dislocation; report of two cases. J Bone Joint Surg (Br), 1951, 33B(2): 244-247.
2. Sabo MT, Watts AC. Reconstructing the interosseous membrane: a technique using synthetic graft and endobuttons. Tech Hand Up Extrem Surg, 2012, 16(4): 187-193.
3. Adams JE, Osterman MN, Osterman AL. Interosseous membrane reconstruction for forearm longitudinal instability. Tech Hand Up Extrem Surg, 2010, 14(4): 222-225.
4. Brin YS, Palmanovich E, Bivas A, et al. Treating acute Essex-Lopresti injury with the TightRope device: a case study. Tech Hand Up Extrem Surg, 2014, 18(1): 51-55.
5. Fomaino MM, Pfaeffle J, Stabile K, et al. Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg (Br), 2003, 28(3): 267-270.
6. Miller AJ, Naik TU, Seigerman DA, et al. anatomic interosseus membrane reconstruction utilizing the biceps button and screw tenodesis for essex-lopresti injuries.Tech Hand Up Extrem Surg, 2016, 20(1): 6-13.
7. Tejwani SG, Markolf KL, Benhaim P. Reconstruction of the interosseous membrane of the forearm with a graft substitute: a cadaveric study. J Hand Surg (Am), 2005, 30(2): 326-334.
8. Tejwani SG, Markolf KL, Benhaim P. Graft reconstruction of the interosseous membrane in conjunction with metallic radial head replacement: a cadaveric study. J Hand Surg (Am), 2005, 30(2): 335-342.
9. Pfaeffle HJ, Stabile KJ, Li ZM, et al. Reconstruction of the interosseous ligament restores normal forearm compressive load transfer in cadavers. J Hand Surg (Am), 2005, 30(2): 319-325.
10. Ruch DS, Chang DS, Koman LA. Reconstruction of longitudinal stability of the forearm after disruption of interosseous ligament and radial head excision (Essex-Lopresti lesion). J South Orthop Assoc, 1999, 8(1): 47-52.
11. Poitevin LA. Anatomy and biomechanics of the interosseous membrane: its importance in the longitudinal stability of the forearm. Hand Clin, 2001, 17(1): 97-110, vii.
12. Marcotte AL, Osterman AL. Longitudinal radioulnar dissociation: identification and treatment of acute and chronic injuries. Hand Clin, 2007, 23(2): 195-208, vi.
13. Chloros GD, Wiesler ER, Stabile KJ, et al. Reconstruction of essex-lopresti injury of the forearm: technical note. J Hand Surg (Am), 2008, 33(1): 124-130.
14. Oberlin C, Belkheyar Z, Soubeyrand M, et al. Semitendinosus ligamentoplasty of the forearm interosseous membrane in a case of Essex-Lopresti syndrome. J Orthop Surg Traumatol, 2006, 16: 164-168.
15. Soubeyrand M, Oberlin C, Dumontier C, et al. Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure. Surg Radiol Anat, 2006, 28(3): 300-307.
16. 郭建邦, 李武, 黄小敬, 等.旋前圆肌肌腱重建骨间膜中央束对Essex-Lopresti损伤后前臂纵向稳定的作用.中华创伤杂志, 2010, 26(3): 234-237.
17. Hoshino CM, Tran W, Tiberi JV, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg (Am), 2013, 95(7): 653-659.
18. Lanting BA, Ferreira LM, Johnson JA, et al. The effect of excision of the radial head and metallic radial head replacement on the tension in the interosseous membrane. Bone Joint J, 2013, 95-B(10): 1383-1387.
19. Orbay JL, Mijares MR, Berriz CG. The transverse force experienced by the radial head during axial loading of the forearm: A cadaveric study. Clin Biomech (Bristol, Avon), 2016, 31: 117-122.

Chinese Journal of Reparative and Reconstructive Surgery

A biomechanical study on reconstruction of forearm interosseous membrane using extensor carpi radialis longus combined with radial head replacement for restoring forearm longitudinal stability

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