Distal interosseous membrane of the forearm: anatomy, biomechanics, diagnostics

Relevance. Recent studies show that even with damage to the structures of the triangular fibrocartilaginous complex (primary stabilizer), instability of the distal ray-elbow joint does not develop in some cases. Studies carried out by a number of authors prove that the distal interosseous membrane of the forearm can influence the stability of the joint and be a secondary stabilizer for it. Aim of the study. To study the variability in the structure of the distal interosseous membrane of the forearm using anatomical material and determine the effect of the distal interosseous membrane on the stability of the distal ray-elbow joint. Using ultrasound to determine the variability of the structure of the distal interosseous membrane of the forearm. Materials and methods. Material for our study was 10 pairs of anatomical specimens of the upper extremities. The functional viability was assessed by passive rotation of the anatomical material of the forearm. Changes in the tension of the distal interosseous membrane, its additional formations and the capsule of the distal ray-elbow joint were observed. Ultrasound was chosen as an instrumental method for visualizing the distal interosseous membrane of the forearm and its structures. In the course of this work, 30 volunteers of both sexes and different ages were examined. The study was carried out: maximum pronation (position of the sensor back) and maximum supination (position of the sensor palmar). Results. In the course of the anatomical study, we determined that in 6 pairs of anatomical material, the distal interosseous membrane is a thin transparent connective tissue structure. No additional formations in the form of thickening were found. In 4 pairs of preparations, which amounted to 40% of the total amount in the distal interosseous membrane, there were additional formations in the form of thickening of the membrane this is the distal oblique bundle and the distal ray-the ulnar tract. During the functional study, it was revealed that during pronation of the forearm, the distal membrane and dorsal capsule are stretched, which in turn holds the head of the ulna in the sigmoid notch of the radius. After conducting ultrasound, we determined the variability in the structure of the distal interosseous membrane of the forearm. The distal oblique bundle is visualized as a linear hyperechoic formation. Of the 30 surveyed, this formation was identified in 13 women (92.8%) and 1 man (7.1%), which in percentage terms was 43%. Conclusion. After conducting anatomical examination, we determined the variability in the structure of the distal interosseous membrane of the forearm in the form of the presence of thickenings the distal oblique bundle and the distal ray-ulnar tract, and determined the effect of these structures on the stability of the distal ray-elbow joint. An ultrasound scan also identified the features in the structure of the distal interosseous membrane in the form of hyperechoic formation.

Orthopedic aspects of functional connective-tissue mobility structures in development and course of intra-articular pathology of knee joint

Objective. To reveal the influence of functional mobility of connective-tissue structures on the development and course of intra-articular pathology of the knee joint. Materials and methods. Patients (n = 279) with intra-articular pathology of the knee joint after the arthroscopic treatment were examined. The state of functional mobility of connective-tissue structures was diagnosed using the express method for dysplastic state of connective tissues in conditions of ambulatory-polyclinic service. Statistical analysis was carried out with Pirson correlation criteria. Results. The paper is devoted to analysis of the influence of functional connective-tissue structure mobility on the development and course of intra-articular pathology of the knee joint. Subjects with low functional mobility of the connective-tissue structures were established to be more often subjected to chondromalacia of cartilaginous tissue of the femoral medial condyle and injury of the medial meniscus. Such pathology as slipping patella, Goff body hypertrophy and knee joint chondromatosis are typical for subjects with hypermobility of the connective-tissue structures. Conclusions. High degree of functional mobility of connective-tissue structures significantly contributes to preservation of cartilaginous cover of the femoral medial condyle, even with concomitant pathology of the knee joint available. For men with high functional mobility of connective-tissue structures, the most common diseases are knee joint chondromatosis and Goff body hypertrophy, and for women slipping patella. For women with low functional mobility of connective-tissue structures, the most typical is pathology of the medial meniscus.

Joints and connective tissue—structure and function

Synovial joints are complex functional elements of the vertebrate body that provide animals with motion capabilities and hence the ability for locomotion and direct physical interaction with their environment. They are composed of different connective tissues structures that are derived from the same developmental structures in the embryo but have distinct cellular and biochemical properties. Articular cartilage and synovial membrane are key components of synovial joints and show several peculiarities that makes them different from other tissues. An in-depth knowledge of these features is important not only for understanding key features of articular function, but also providing explanations for important characteristics of both degenerative and inflammatory joint diseases. This chapter reviews the structure, biochemical composition, and function of articular cartilage and synovium, and points to important links between physiology and pathologic conditions, particularly arthritis.

Targeting Polymeric Nanobiomaterials as a Platform for Cartilage Tissue Engineering

Articular cartilage is a connective tissue structure that is found in anatomical areas that are important for the movement of the human body. Osteoarthritis is the ailment that most often affects the articular cartilage. Due to its poor intrinsic healing capacity, damage to the articular cartilage is highly detrimental and at present the reconstructive options for its repair are limited. Tissue engineering and the science of nanobiomaterials are two lines of research that together can contribute to the restoration of damaged tissue. The science of nanobiomaterials focuses on the development of different nanoscale structures that can be used as carriers of drugs / cells to treat and repair damaged tissues such as articular cartilage. This review article is an overview of the composition of articular cartilage, the causes and treatments of osteoarthritis, with a special emphasis on nanomaterials as carriers of drugs and cells, which reduce inflammation, promote the activation of biochemical factors and ultimately contribute to the total restoration of articular cartilage.

Express diagnosis of connective tissue dysplasia in conditions of ambulatory-polyclinic service

Aim. To detect the most informative signs of connective tissue dysplasia (CTD) and develop the method for CTD express diagnosis in conditions of ambulatory and stationary traumatologo-orthopedic service. Materials and methods. Sixty practically healthy persons were examined. To diagnose the connective tissue pathology, there were used the criteria developed by S.K. Evtushenko (2002), T.Yu. Smolnova (2003) and T.I. Kartunova (2006). Eighteen the most informative criteria were chosen. Results. The paper is devoted to a widespread and yet not fully studied problem – the connective tissue dysplasia. The basic signs of this disease were analyzed. The most informative criteria of connective tissue dysplasia were singled out. Express test for primary diagnosis of this pathology in conditions of traumatologo-orthopedic service was offered. Conclusions. Express test of the state of connective tissue structure is simple to perform. It can be used to improve surgical aids in connective tissue dysplasia, when additional stabilization of loco motor system is required.

Connective tissue injury in calf muscle tears and return to play: MRI correlation

ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.