Interosseous Membrane of the Forearm

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: Essex–Lopresti injury; central band; distal radial ulnar joint; interosseous membrane; proximal radial ulnar joint.

Fig. 1

(A) A 28-year-old male patient injured in high-energy fall—AP forearm demonstrates a displaced radial head and dislocated DRUJ consistent with an Essex–Lopresti injury. (B) Lateral of the forearm of the same patient as Fig. 1A. (C) AP wrist showing the markedly ulnar plus deformity secondary to injury to the IOM. AP, anteroposterior; DRUJ, distal radial ulnar joint; IOM, interosseous membrane.

Fig. 2

(A) Ulnar variance of same patient as in Fig. 1, 1-year postoperatively, treated acutely with reconstruction of the IOM with semitendinosis allograft, tight rope, distal pinning, and radial head replacement. Note that this patient is only slightly ulnar positive. (B) Lateral 1-year postoperative image of the elbow with the radial head well centered. (C) AP of the elbow 1-year postoperatively. There is no overstuffing of the radial head and no significant capitellar erosion at this point. AP, anteroposterior; IOM, interosseous membrane.

Fig. 3

(A) Lateral radiograph of a chronic Essex–Lopresti injury s/p five procedures, 2 years after the last procedure, which was excision of the failed radial head implant, reconstruction of the IOM with semitendinosis allograft, fibertape double dog bones, ulnar shortening, and DRUJ ligament reconstruction with allograft semitendinosis. (B) AP forearm of the same patient 2 years postoperatively. She reports little to no pain in the wrist and elbow but poor forearm rotation. AP, anteroposterior; DRUJ, distal radial ulnar joint; IOM, interosseous membrane; s/p, status post.