Distal-Ulna Stump Stability: The Role of Distal Interosseous Membrane: Myth or Reality? Anatomical Research

Hand ◽  
2021 ◽  
pp. 155894472199972
Author(s):  
Luciano A. Poitevin ◽  
Daniel Postan ◽  
Sergio Valente
Keyword(s):  
Distal Radioulnar Joint ◽  
Interosseous Membrane ◽  
Distal Ulna ◽  
Lateral Border ◽  
Fresh Frozen ◽  
Additional Stability ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Anatomical Research

Background Distal-ulna stump (DUS) instability often occurs when performing a distal radioulnar joint (DRUJ) arthroplasty. Recent studies suggest that the distal interosseous membrane (DIOM) reinforces the triangular fibrocartilage complex, providing additional stability to the DRUJ. The aim of this study was to determine whether the DIOM stabilizes the ulnar stump. Methods Twenty fresh-frozen random forearms were dissected. The presence of a distal oblique bundle (DOB) was recorded and measured. The radius was fixed to a vise and the ulna kept free. The DRUJ was fixed with a lag screw. A bone slice was removed by transverse ulna osteotomies 10 and 15 mm proximal to the DRUJ. A 10-N force was applied to the ulna in dorsal and volar directions. Displacements were measured. The DIOM was then transected, and maneuvers and measurements were repeated and compared. Results A distinct distal membrane was present in 70% and a cord-like DOB in 30%. The mean length was 29 mm. Its origin was proximal to the sigmoid notch; its insertion was on the distal third of the ulna, at its lateral border. This attachment is comprised between 39 and 48 mm proximal to the ulnocarpal joint. Initial displacements averaged 22 mm dorsally and 13 mm volarly. After DIOM transection, ulnar translocation increased to 31 mm dorsally and 19 mm volarly. Conclusion In DRUJ arthroplasties, the DIOM does not appear to be a stabilizer of the DUS beneath a useful threshold. Its retaining effect occurs only after an initial 22-mm dorsal displacement, which we consider not clinically admissible. Therefore, in DRUJ arthroplasties, some augmentation might be advisable.

CT Scan versus Saline Load Test for Detection of Traumatic Wrist Arthrotomy

2021 ◽  
Author(s):  
Eric Perloff ◽  
Andrew Posner ◽  
Hamza Murtaza ◽  
Khushdeep Vig ◽  
Michael Smith ◽  
...  
Keyword(s):  
Ct Scan ◽  
Distal Radioulnar Joint ◽  
Load Test ◽  
Portal Site ◽  
Radioulnar Joint ◽  
Radiocarpal Joint ◽  
Fresh Frozen ◽  
The Mean ◽  
Midcarpal Joint ◽  
Cadaveric Model

Abstract Background Traumatic arthrotomy of the wrist is most commonly detected using the saline load test (SLT); however, little data exists on the effectiveness of the SLT to this specific joint. The use of computed tomography (CT) scan has been validated as an alternative method to detect traumatic arthrotomy of the knee, as the presence of intra-articular air can be seen when there is violation of the joint capsule. Question/Purpose The purpose of this study was to determine the ability of CT scan to identify arthrotomy of the wrist capsule and compare the diagnostic performance of CT versus traditional SLT. Materials and Methods Ten fresh frozen cadavers which had undergone transhumeral amputation were initially used in this study. A baseline CT scan was performed to ensure no intra-articular air existed prior to intervention. After baseline CT, an arthrotomy was created at the 6R radiocarpal portal site. The wrists then underwent a postarthrotomy CT to identify the presence or absence of intra-articular air. Following CT, the wrists were subjected to the SLT to detect the presence of extravasation from the arthrotomy. Results Nine cadavers were included following baseline CT scan. Following arthrotomy, intra-articular air was visualized in eight of the nine cadavers in the postarthrotomy CT scan. Air was seen in the radiocarpal joint in eight of the nine wrists; midcarpal joint in seven of the nine wrists; and distal radioulnar joint in six of the nine wrists. All wrists (nine of the nine) demonstrated extravasation during the SLT. The mean volume of extravasation occurred at 3.7 mL (standard deviation = 2.6 mL), with a range of 1 to 7 mL. Conclusion CT scan correctly identified eight of the nine simulated traumatic arthrotomies. Injection of 7 mL during the SLT was necessary to identify 100% of the arthrotomies. Clinical Relevance CT scan is a sensitive modality for detection of traumatic arthrotomy of the wrist in a cadaveric model.

scholarly journals The Optimal Suture Placement and Bone Tunnels for TFCC Repair: A Cadaveric Study

2018 ◽  
Vol 07 (05) ◽  
pp. 375-381 ◽  
Author(s):  
Peter Tang ◽  
Keiji Fujio ◽  
Robert Strauch ◽  
Melvin Rosenwasser ◽  
Taiichi Matsumoto
Keyword(s):  
Distal Radioulnar Joint ◽  
Radioulnar Joint ◽  
Ulnar Head ◽  
Transosseous Repair ◽  
Triangular Fibrocartilage ◽  
The Mean ◽  
Group 5 ◽  
Bone Tunnels ◽  
Isometric Point ◽  
Suture Placement

Background Transosseous repair of foveal detachment of the triangular fibrocartilage complex (TFCC) is effective for distal radioulnar joint stabilization. However, studies of the optimal foveal and TFCC suture positions are scant. Purpose The purpose of this study was to clarify the optimal TFCC suture position and bone tunnels for transosseous foveal repair. Materials and Methods Seven cadavers were utilized. The TFCC was incised at the foveal insertion and sutured at six locations (TFCCs 1–6) using inelastic sutures. Six osseous tunnels were created in the fovea (foveae 1–6). Fovea 2 is located at the center of the circle formed by the ulnar head overlooking the distal end of the ulna (theoretical center of rotation); fovea 5 is located 2 mm ulnar to fovea 2. TFCC 5 is at the ulnar apex of the TFCC disc; TFCC 4 is 2 mm dorsal to TFCC 5. TFCC 1 to 6 sutures were then placed through each of the six osseous tunnels, resulting in 36 combinations, which were individually tested. The forearm was placed in five positions between supination and pronation, and the degree of suture displacement was measured. The position with the least displacement indicated the isometric point of the TFCC and fovea. Results The mean distance of suture displacement was 2.4 ± 1.6 mm. Fovea 2, combined with any TFCC location, (0.7 ± 0.6 mm) and fovea group 5, combined with TFCC 4 location (0.8 ± 0.8) or with TFCC 5 location (0.9 ± 0.6) had statistically shorter suture displacements than any other fovea groups. Conclusion For TFCC transosseous repair, osseous tunnel position was more important than TFCC suture location.

scholarly journals Reconstruction of the Distal Oblique Bundle of the Interosseous Membrane with Extensor Carpi Radialis Hemitendon: A New Minimally-Invasive Technique

2020 ◽  
Vol 48 (02) ◽  
pp. 138-142
Author(s):  
Francisco Martínez-Martínez ◽  
Alberto Giménez-Ros ◽  
Vicente J. León-Muñoz ◽  
Fernando Santonja-Medina
Keyword(s):  
Minimally Invasive ◽  
Therapeutic Option ◽  
Distal Radioulnar Joint ◽  
Minimally Invasive Technique ◽  
Interosseous Membrane ◽  
Invasive Technique ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Extensor Carpi Radialis ◽  
Stabilizing Element

AbstractThe main stabilizing element of the distal radioulnar joint (DRUJ) is the triangular fibrocartilage complex (TFCC). Secondary stabilizers include the distal oblique band (DOB), which is inconsistently found. When TFCC repair has failed or cannot be performed, DOB reconstruction is a therapeutic option. Even though distal radioulnar ligamentoplasty remains the technique of choice, recent papers show similar outcomes from both methods. We present two cases of successful DOB repair with the extensor carpi radialis longus (ECRL) hemitendon.

Acute blocking of forearm supination secondary to tearing of the triangular fibrocartilage complex

2020 ◽  
Vol 45 (9) ◽  
pp. 939-944
Author(s):  
Taku Suzuki ◽  
Toshiyasu Nakamura ◽  
Yoshihiko Tanino ◽  
Yukihiko Obara ◽  
Yasuhiro Yoshikawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Arthroscopic Surgery ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Minor Trauma ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
Open Operation ◽  
Triangular Fibrocartilage ◽  
The Mean

We studied the characteristics of acute blocking of supination of the distal radioulnar joint caused by triangular fibrocartilage complex injuries. Twenty-four patients who were treated for acute blocking of supination were retrospectively assessed. Supination was suddenly blocked after minor trauma to the wrist. Active and passive supination was severely restricted with a mean preoperative range of motion (11°), whereas pronation was almost normal. The cause was identified arthroscopically or at open operation. It was found to be a result of avulsion of the dorsal or palmar portion of the radioulnar ligament, which blocked movement of the ulnar head. Blocking was reduced manually in four cases, by arthroscopic surgery in eight cases and by open surgery in 12 cases. After treatment, forearm supination improved to 84° of the mean range of motion. Distal radioulnar joint blocking from a ruptured triangular fibrocartilage complex should be considered in the differential diagnosis of loss of forearm supination. Level of evidence: IV

The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability

1994 ◽  
Vol 19 (3) ◽  
pp. 385-393 ◽  
Author(s):  
Richard S. Rabinowitz ◽  
Terry R. Light ◽  
Robert M. Havey ◽  
Prassad Gourineni ◽  
Avinash G. Patwardhan ◽  
...  
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Interosseous Membrane ◽  
Triangular Fibrocartilage ◽  
Forearm Stability

Evolution of the Ring Concept for the Forearm and Its Implication on Treatment: From Galeazzi, Monteggia, Essex-Lopresti, and Darrach to the Current Era

2019 ◽  
Vol 24 (03) ◽  
pp. 251-257 ◽  
Author(s):  
Kate Elzinga ◽  
Kevin Chung
Keyword(s):  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Interosseous Membrane ◽  
Annular Ligament ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage ◽  
Essex Lopresti ◽  
Forearm Injuries

Geometrically, rings distribute their stress along their arc instead of concentrating at any one point. The forearm ring is composed of the radius, ulna, proximal radioulnar joint, and distal radioulnar joint. The annular ligament, interosseous membrane, and triangular fibrocartilage complex link and stabilize the ring. Injuries to the forearm occur along a continuum with recognized patterns of ring disruption, including Galeazzi, Monteggia, and Essex-Lopresti injuries. The Darrach procedure causes a disruption to the forearm ring and can lead to painful convergence between the radius and distal ulnar stump. Injuries to the forearm ring are unstable. Management of forearm injuries is centered on the restoration of the anatomy and stability of the forearm ring. Forearm ring injuries and their treatment are discussed in this article.

scholarly journals A Misdiagnosis of Traumatic Hypersupination of the Distal Radioulnar Joint: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Vipin Asopa ◽  
Robert J. Douglas ◽  
Andrew D. Saies ◽  
James S. Church
Keyword(s):  
Case Report ◽  
Anatomical Variation ◽  
Distal Radioulnar Joint ◽  
Review Of The Literature ◽  
Ulnar Styloid ◽  
Distal Ulna ◽  
Radiological Investigation ◽  
Rare Injury ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

Traumatic hypersupination injury of the distal radioulnar joint is a rare injury, and occurs when sufficient supination force is applied to the joint so as to tear the volar radioulnar ligament, resulting in separation of the triangular fibrocartilage complex, and subluxation of the tendon of extensor carpi ulnaris. This allows the distal ulna to rotate such that the ulnar styloid comes to lie adjacent to the ulna notch of the radius. Treatment of this injury requires manipulation of the joint, under anaesthesia or sedation. We describe a case where posttraumatic radiological investigation of a patient with an anatomical variation of the wrist when in supination resembled a traumatic hypersupination injury of the distal radioulnar joint. A review of the literature has revealed this to be the first reported case of this type.

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