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. 2018 Feb 23;53(2):184-191.
doi: 10.1016/j.rboe.2018.02.010. eCollection 2018 Mar-Apr.

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint

Márcio Aurélio Aita  1 , Ricardo Carvalho Mallozi  1 , Willian Ozaki  1 , Douglas Hideo Ikeuti  1 , Daniel Alexandre Pereira Consoni  2 , Gustavo Mantovanni Ruggiero  3
Affiliations

Ligamentous reconstruction of the interosseous membrane of the forearm in the treatment of instability of the distal radioulnar joint

Márcio Aurélio Aita et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objectives: To measure the quality of life and clinical outcomes of patients treated with interosseous membrane (IOM) ligament reconstruction of the forearm, using the brachioradialis (BR), and describe a new surgical technique for the treatment of joint instability of the distal radioulnar joint (DRUJ).

Methods: From January 2013 to September 2016, 24 patients with longitudinal injury of the distal radioulnar joint DRUJ were submitted to surgical treatment with a reconstruction procedure of the distal portion of the interosseous membrane or distal oblique band (DOB). The clinical-functional and radiographic parameters were analyzed and complications and time of return to work were described.

Results: The follow-up time was 20 months (6-36). The ROM averaged 167.92° (93.29% of the normal side). VAS was 2/10 (1-6). DASH was 5.63/100 (1-18). The time to return to work was 7.37 months (3-12). As to complications, one patient had an unstable DRUJ, and was submitted to a new reconstruction by the Brian-Adams technique months. Currently, he has evolved with improved function, and has returned to his professional activities. Three other patients developed problems around the transverse K-wire and were treated with its removal, all of whom are doing well.

Conclusion: The new approach presented in this study is safe and effective in the treatment of longitudinal instability of the DRUJ, since it has low rate of complications, as well as satisfactory radiographic, clinical, and functional results. It allows return to social and professional activities, and increases the quality of life of these patients.

Objetivos: Mensurar a qualidade de vida e os resultados clínico-funcionais dos pacientes submetidos à reconstrução ligamentar de membrana interóssea (MIO) do antebraço com o uso do braquioestilorradial (BR) e descrever uma nova técnica cirúrgica.

Método: De janeiro de 2013 a setembro de 2016, 24 pacientes com lesão longitudinal da articulação radioulnar distal (ARUD) foram submetidos ao tratamento cirúrgico de reconstrução da porção distal da membrana interóssea ou distal oblique band (DOB). Foram analisados os parâmetros clínico-funcionais e radiográficos e descritos as complicações e o tempo de retorno ao trabalho.

Resultados: O tempo de seguimento foi de 20 meses [6-36]. A ADM foi em média 167,92° (93,29% do lado normal). A VAS foi 2/10 [1-6]. O DASH foi de 5,63/100 [1-18]. O tempo de retorno ao trabalho foi de 7,37 meses [3-12]. Quanto às complicações, um paciente evoluiu com instabilidade da ARUD e foi submetido a nova reconstrução pela técnica de Brian-Adams. Evoluiu com melhoria funcional e retornou às atividades profissionais. Outros três pacientes evoluíram com problemas ao redor do fio de Kirschner transverso à ARUD e foram tratados com a remoção desse, todos evoluíram bem.

Conclusão: A nova abordagem apresentada neste estudo demonstrou-se segura e eficaz no tratamento da instabilidade longitudinal da ARUD, já que apresentou baixa taxa de complicações, bem como resultados radiográficos, clínicos e funcionais satisfatórios, o que melhorou a qualidade de vida desses pacientes.

Keywords: Forearm injuries/surgery; Joint instability; Joint ligaments; Joint range of motion; Membranes/injuries.

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Figures

Fig. 1
Fig. 1
Schematic illustration of the IOM; featuring the distal portion (DOB).
Fig. 2
Fig. 2
Lateral and anteroposterior view radiographs of the wrist demonstrating the instability of the DRUJ.
Fig. 3
Fig. 3
Photograph of a cadaveric specimen and illustrative drawing demonstrating the technique of DOB reconstruction with BR.
Fig. 4
Fig. 4
Intraoperative clinical and radiographic aspects demonstrating BR tendon grafting.
Fig. 5
Fig. 5
Postoperative clinical and radiographic aspects after reconstruction.
Fig. 6
Fig. 6
Pre and postoperative radiographic aspects of the patient (ulnar lengthening).
Fig. 7
Fig. 7
Post-operative clinical and radiographic aspects of IOM reconstruction and radial head reduction.
See this image and copyright information in PMC

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