Interosseous Membrane of the Forearm
28 April 2016
03 May 2016
13 June 2016 (online)
Background Injuries of the interosseous membrane (IOM) of the forearm are frequently unrecognized, difficult to treat, and can result in a devastating sequelae for the wrist and elbow.
Purpose The purpose of this review article is to evaluate the dignosis, biomechanics, clinical results, and propose a treatment approach to this rare complex entity.
Methods The biomechanical and clinical literature is reviewed. A treatment approach is described based on the known biomechanics and clinical experience of the senior author (T. W. W.).
Results Multiple different reconstructive methods have been proposed for the treatment of both acute and chronic IOM injuries. The results of the published series are reviewed. IOM injuries can have reasonable outcomes particularly if diagnosed and treated early.
Conclusion There are multiple methods for treating patients with IOM injuries. Physicians should be highly suspicious about this injury when a patient presents with a highly displaced radial head fracture associated with wrist pain. Treatment with reconstruction of the cerebral band of the IOM with radial head replacement (do not overstuff) and temporary uploading the construct with K-wires from the ulna to the radius will give the most predictable results.
- 1 Wright TW, Glowczewskie F. Vascular anatomy of the ulna. J Hand Surg Am 1998; 23 (5) 800-804
- 2 Pfaeffle HJ, Stabile KJ, Li ZM, Tomaino MM. Reconstruction of the interosseous ligament unloads metallic radial head arthroplasty and the distal ulna in cadavers. J Hand Surg Am 2006; 31 (2) 269-278
- 3 Kapandji A. Biomechanics of pronation and supination of the forearm. Hand Clin 2001; 17 (1) 111-122 , vii
- 4 Hollister AM, Gellman H, Waters RL. The relationship of the interosseous membrane to the axis of rotation of the forearm. Clin Orthop Relat Res 1994; (298) 272-276
- 5 Noda K, Goto A, Murase T, Sugamoto K, Yoshikawa H, Moritomo H. Interosseous membrane of the forearm: an anatomical study of ligament attachment locations. J Hand Surg Am 2009; 34 (3) 415-422
- 6 Skahen III JR, Palmer AK, Werner FW, Fortino MD. The interosseous membrane of the forearm: anatomy and function. J Hand Surg Am 1997; 22 (6) 981-985
- 7 McGinley JC, Heller JE, Fertala A, Gaughan JP, Kozin SH. Biochemical composition and histologic structure of the forearm interosseous membrane. J Hand Surg Am 2003; 28 (3) 503-510
- 8 Birkbeck DP, Failla JM, Hoshaw SJ, Fyhrie DP, Schaffler M. The interosseous membrane affects load distribution in the forearm. J Hand Surg Am 1997; 22 (6) 975-980
- 9 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
- 10 Halls AA, Travill A. Transmission of pressures across the elbow joint. Anat Rec 1964; 150: 243-247
- 11 Markolf KL, Dunbar AM, Hannani K. Mechanisms of load transfer in the cadaver forearm: role of the interosseous membrane. J Hand Surg Am 2000; 25 (4) 674-682
- 12 Hotchkiss RN, An KN, Sowa DT, Basta S, Weiland AJ. An anatomic and mechanical study of the interosseous membrane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg Am 1989; 14 (2 Pt 1): 256-261
- 13 Rabinowitz RS, Light TR, Havey RM , et al. The role of the interosseous membrane and triangular fibrocartilage complex in forearm stability. J Hand Surg Am 1994; 19 (3) 385-393
- 14 Morrey BF, Chao EY, Hui FC. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am 1979; 61 (1) 63-68
- 15 Arimitsu S, Moritomo H, Kitamura T , et al. The stabilizing effect of the distal interosseous membrane on the distal radioulnar joint in an ulnar shortening procedure: a biomechanical study. J Bone Joint Surg Am 2011; 93 (21) 2022-2030
- 16 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (7) 1501-1507
- 17 Kitamura T, Moritomo H, Arimitsu S , et al. The biomechanical effect of the distal interosseous membrane on distal radioulnar joint stability: a preliminary anatomic study. J Hand Surg Am 2011; 36 (10) 1626-1630
- 18 Watanabe H, Berger RA, Berglund LJ, Zobitz ME, An KN. Contribution of the interosseous membrane to distal radioulnar joint constraint. J Hand Surg Am 2005; 30 (6) 1164-1171
- 19 Riggenbach MD, Wright TW, Dell PC. Reconstruction of the distal oblique bundle of the interosseous membrane: a technique to restore distal radioulnar joint stability. J Hand Surg Am 2015; 40 (11) 2279-2282
- 20 Riggenbach MD, Conrad BP, Wright TW, Dell PC. Distal oblique bundle reconstruction and distal radioulnar joint instability. J Wrist Surg 2013; 2 (4) 330-336
- 21 Brink PR, Hannemann PF. Distal oblique bundle reinforcement for treatment of DRUJ instability. J Wrist Surg 2015; 4 (3) 221-228
- 22 Trousdale RT, Amadio PC, Cooney WP, Morrey BF. Radio-ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 1992; 74 (10) 1486-1497
- 23 Wallace AL, Walsh WR, van Rooijen M, Hughes JS, Sonnabend DH. The interosseous membrane in radio-ulnar dissociation. J Bone Joint Surg Br 1997; 79 (3) 422-427
- 24 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
- 25 Kachooei AR, Rivlin M, Shojaie B, van Dijk CN, Mudgal C. Intraoperative technique for evaluation of the interosseous ligament of the forearm. J Hand Surg Am 2015; 40 (12) 2372-6.e1
- 26 Davidson PA, Moseley Jr JB, Tullos HS. Radial head fracture. A potentially complex injury. Clin Orthop Relat Res 1993; (297) 224-230
- 27 Gong HS, Chung MS, Oh JH, Lee YH, Kim SH, Baek GH. Failure of the interosseous membrane to heal with immobilization, pinning of the distal radioulnar joint, and bipolar radial head replacement in a case of Essex-Lopresti injury: case report. J Hand Surg Am 2010; 35 (6) 976-980
- 28 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
- 29 Adams JE, Steinmann SP, Osterman AL. Management of injuries to the interosseous membrane. Hand Clin 2010; 26 (4) 543-548
- 30 Adams JE, Culp RW, Osterman AL. Interosseous membrane reconstruction for the Essex-Lopresti injury. J Hand Surg Am 2010; 35 (1) 129-136
- 31 Adams JE, Osterman MN, Osterman AL. Interosseous membrane reconstruction for forearm longitudinal instability. Tech Hand Up Extrem Surg 2010; 14 (4) 222-225
- 32 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