Interosseus Membrane Reconstruction Following a Forearm Injury: A Case Report

Abstract

Background Essex-Lopresti injuries are complex, frequently missed forearm/elbow injuries consisting of a fracture of the radial head with disruption of both the distal radioulnar joint (DRUJ) and the interosseous membrane (IOM). Ideal management of these injuries remains controversial, especially in relation to the IOM, due in part to underdiagnosis of IOM injury and incomplete understanding of the IOM role.

Methods A 43-year-old man sustained an open radial shaft fracture with associated radial head subluxation, coronoid base fracture, and DRUJ injury with ulnar head subluxation. He was taken for surgery, where elbow instability with near complete disruption of the IOM was observed. Persistent gross rotational instability was noted following radius fixation, so braided suture and button reconstruction of the central band of the IOM was performed. This restored rotational and longitudinal stability to the radiocapitellar joint and DRUJ. Over 1 year out from the index surgery, the patient's elbow and DRUJ have remained stable, and he is back working as a laborer.

Results While little literature exists on outcomes of acute IOM reconstruction in these injuries, recent biomechanical studies have shown the importance of the central band on rotational elbow stability.

Conclusion This case supports the importance of the central band of the IOM by demonstrating the impact of its repair on the longitudinal and rotational stability of the elbow and DRUJ. IOM repair has the potential to improve our treatment of this complicated injury by better restoring forearm stability and function of the elbow, which future studies could help further elucidate.

Keywords

interosseous membrane - Essex-Lopresti injury - forearm injury - DRUJ injury - radiocapitellar joint

Publication History

Received: 29 March 2023

Accepted: 18 July 2023

Article published online:
26 September 2023

• References

• 1 Grassmann JP, Hakimi M, Gehrmann SV. et al. The treatment of the acute Essex-Lopresti injury. Bone Joint J 2014; 96-B (10) 1385-1391
• 2 Matthias R, Wright TW. Interosseous membrane of the forearm. J Wrist Surg 2016; 5 (03) 188-193
• 3 Anderson A, Werner FW, Tucci ER, Harley BJ. Role of the interosseous membrane and annular ligament in stabilizing the proximal radial head. J Shoulder Elbow Surg 2015; 24 (12) 1926-1933
• 4 Gaspar MP, Kane PM, Pflug EM, Jacoby SM, Osterman AL, Culp RW. Interosseous membrane reconstruction with a suture-button construct for treatment of chronic forearm instability. J Shoulder Elbow Surg 2016; 25 (09) 1491-1500
• 5 Hackl M, Andermahr J, Staat M. et al. Suture button reconstruction of the central band of the interosseous membrane in Essex-Lopresti lesions: a comparative biomechanical investigation. J Hand Surg Eur Vol 2017; 42 (04) 370-376
• 6 Meals CG, Forthman CL, Segalman KA. Suture-button reconstruction of the interosseous membrane. J Wrist Surg 2016; 5 (03) 179-183
• 7 Marcotte AL, Osterman AL. Longitudinal radioulnar dissociation: identification and treatment of acute and chronic injuries. Hand Clin 2007; 23 (02) 195-208 , vi
• 8 Schnetzke M, Porschke F, Hoppe K, Studier-Fischer S, Gruetzner PA, Guehring T. Outcome of early and late diagnosed Essex-Lopresti injury. J Bone Joint Surg Am 2017; 99 (12) 1043-1050
• 9 Charlotte G, Honecker S, Xavier F, Facca S, Lazarus P, Liverneaux P. Acute Essex-Lopresti syndrome: about a case of brachioradialis tendon transfer. J Wrist Surg 2021; 11 (01) 76-80
• 10 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 (01) 51-55
• 11 Interosseous membrane of forearm. Wikipedia. January 8, 2022. Accessed June 23, 2023 at: https://en.wikipedia.org/wiki/Interosseous_membrane_of_forearm