Download PDF
J Wrist Surg 2016; 05(03): 188-193
DOI: 10.1055/s-0036-1584326
Special Focus Section: Interosseous Membrane and Its Effect on DRUJ
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Interosseous Membrane of the Forearm

Robert Matthias
1   Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida
,
Thomas W. Wright
2   Orthopaedics and Sports Medicine Institute, University of Florida, Gainesville, Florida
› Author Affiliations
Further Information

Publication History

28 April 2016

03 May 2016

Publication Date:
13 June 2016 (online)

    Permissions and Reprints

Abstract

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.

Keywords

central band - distal radial ulnar joint - Essex–Lopresti injury - interosseous membrane - proximal radial ulnar joint
 

  • References

  • 1 Wright TW, Glowczewskie F. Vascular anatomy of the ulna. J Hand Surg Am 1998; 23 (5) 800-804
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Kapandji A. Biomechanics of pronation and supination of the forearm. Hand Clin 2001; 17 (1) 111-122 , vii
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Palmer AK, Werner FW. Biomechanics of the distal radioulnar joint. Clin Orthop Relat Res 1984; (187) 26-35
    PubMedGoogle Scholar
  • 10 Halls AA, Travill A. Transmission of pressures across the elbow joint. Anat Rec 1964; 150: 243-247
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 16 Moritomo H. The distal interosseous membrane: current concepts in wrist anatomy and biomechanics. J Hand Surg Am 2012; 37 (7) 1501-1507
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Brink PR, Hannemann PF. Distal oblique bundle reinforcement for treatment of DRUJ instability. J Wrist Surg 2015; 4 (3) 221-228
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 26 Davidson PA, Moseley Jr JB, Tullos HS. Radial head fracture. A potentially complex injury. Clin Orthop Relat Res 1993; (297) 224-230
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Adams JE, Steinmann SP, Osterman AL. Management of injuries to the interosseous membrane. Hand Clin 2010; 26 (4) 543-548
    CrossrefPubMedGoogle Scholar
  • 30 Adams JE, Culp RW, Osterman AL. Interosseous membrane reconstruction for the Essex-Lopresti injury. J Hand Surg Am 2010; 35 (1) 129-136
    CrossrefPubMedGoogle Scholar
  • 31 Adams JE, Osterman MN, Osterman AL. Interosseous membrane reconstruction for forearm longitudinal instability. Tech Hand Up Extrem Surg 2010; 14 (4) 222-225
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar