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The Stabilizing Effect of the Distal Interosseous Membrane on the Distal Radioulnar Joint in an Ulnar Shortening Procedure: A Biomechanical Study
Sayuri Arimitsu, MD1; Hisao Moritomo, MD2; Takashi Kitamura, MD1; Lawrence J. Berglund, BS1; Kristin D. Zhao, MA1; Kai-Nan An, PhD1; Marco Rizzo, MD1
1 Biomechanics Laboratory, Division of Orthopedic Research, 200 First Street S.W., Mayo Clinic, Rochester, MN 55905. E-mail address for M. Rizzo: rizzo.marco@mayo.edu
2 Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita 5650871, Japan
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Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Mayo Clinic, Rochester, Minnesota

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Nov 02;93(21):2022-2030. doi: 10.2106/JBJS.J.00411
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Abstract

Background: 

The importance of the stabilizing effect of the distal interosseous membrane on the distal radioulnar joint, especially in patients with a distal oblique bundle, has been described. The purpose of this study was to evaluate the stability of the distal radioulnar joint after an ulnar shortening osteotomy and to quantify longitudinal resistance to ulnar shortening when the osteotomy was proximal or distal to the ulnar attachment of the distal interosseous membrane. These relationships were characterized for forearms with or without a distal oblique bundle.

Methods: 

Ten fresh-frozen cadavers were used. A transverse osteotomy and ulnar shortening was performed proximal (proximal shortening) and distal (distal shortening) to the ulnar attachment of the distal interosseous membrane. Distal radioulnar joint laxity was evaluated as the volar and dorsal displacements of the radius relative to the fixed ulna with 20 N of applied force. Testing was performed under controlled 1-mm increments of ulnar shortening up to 4 mm, with the forearm in neutral alignment, 60° of pronation, and 60° of supination. Resistance to ulnar shortening was quantified as the slope of the load-displacement curve obtained by displacing the distal ulnar segment proximally.

Results: 

In proximal shortening, significantly greater stability of the distal radioulnar joint was obtained with even 1 mm of shortening compared with the control, whereas distal shortening demonstrated significant improvement in stability of the distal radioulnar joint only after shortening of ≥4 mm in all rotational positions. Significantly greater stability of the distal radioulnar joint was achieved with proximal shortening than with distal shortening and in specimens with a distal oblique bundle than in those without a distal oblique bundle. The longitudinal resistance to ulnar shortening was significantly greater in proximal shortening than in distal shortening. The stiffness in proximal shortening was not affected by the presence of a distal oblique bundle in the distal interosseous membrane.

Conclusions: 

Ulnar shortening with the osteotomy carried out proximal to the attachment of the distal interosseous membrane had a more favorable effect on stability of the distal radioulnar joint compared with distal osteotomy, especially in the presence of a distal oblique bundle.

Clinical Relevance: 

When ulnar shortening osteotomy is performed, there is a stabilizing effect on the distal radioulnar joint because of increased tensioning of the distal interosseous membrane.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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