Suture-Button Reconstruction of the Interosseous Membrane
19. Mai 2016
23. Mai 2016
20. Juni 2016 (online)
Background Reconstruction of the interosseous membrane (IOM) may play a role in the treatment of acute and chronic longitudinal forearm instability. Several reconstruction techniques have been proposed. Suture-button reconstruction is attractive because it obviates donor site morbidity and is relatively easy to perform. How this method compares to its alternatives, however, is unknown.
Materials and Methods We review literature describing reconstruction of the forearm axis. We describe how we perform suture-button reconstruction of the IOM, summarize our previously published biomechanical data on the subject, and offer a case report.
Description of Technique A suture-button is implanted so as to approximate the course of the interosseous ligament. This may be accomplished percutaneously, or when grafting is desired, through an open approach.
Results Data informing the choice of one reconstruction technique over another consist mostly of biomechanical studies and a small number of case reports.
Conclusions Suture-button reconstruction of the IOM may encourage anatomic healing of acute forearm axis injuries especially as an adjunct to radial head replacement or repair. Chronic injuries may benefit from a combination suture-button graft construct and ulnar shortening osteotomy.
- 1 Means KJ, Graham T. Disorders of the forearm axis. In: Wolfe S, Hotchkis R, Pederson W, Kozin S, eds. Green's Operative Hand Surgery. 6 ed. London: Elsevier; 2011
- 2 Sowa DT, Hotchkiss RN, Weiland AJ. Symptomatic proximal translation of the radius following radial head resection. Clin Orthop Relat Res 1995; (317) 106-113
- 3 McGinley JC, Kozin SH. Interosseous membrane anatomy and functional mechanics. Clin Orthop Relat Res 2001; (383) 108-122
- 4 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
- 5 Tomaino MM, Pfaeffle J, Stabile K, Li ZM. Reconstruction of the interosseous ligament of the forearm reduces load on the radial head in cadavers. J Hand Surg [Br] 2003; 28 (3) 267-270
- 6 Marcotte AL, Osterman AL. Longitudinal radioulnar dissociation: identification and treatment of acute and chronic injuries. Hand Clin 2007; 23 (2) 195-208 , vi vi
- 7 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
- 8 Drake ML, Farber GL, White KL, Parks BG, Segalman KA. Restoration of longitudinal forearm stability using a suture button construct. J Hand Surg Am 2010; 35 (12) 1981-1985
- 9 Kam CC, Jones CM, Fennema JL, Latta LL, Ouellette EA, Evans PJ. Suture-button construct for interosseous ligament reconstruction in longitudinal radioulnar dissociations: a biomechanical study. J Hand Surg Am 2010; 35 (10) 1626-1632
- 10 Jones CM, Kam CC, Ouellette EA, Milne EL, Kaimrajh D, Latta LL. Comparison of 2 forearm reconstructions for longitudinal radioulnar dissociation: a cadaver study. J Hand Surg Am 2012; 37 (4) 741-747
- 11 Pfaeffle HJ, Stabile KJ, Li ZM, Tomaino MM. Reconstruction of the interosseous ligament restores normal forearm compressive load transfer in cadavers. J Hand Surg Am 2005; 30 (2) 319-325
- 12 Sellman DC, Seitz Jr WH, Postak PD, Greenwald AS. Reconstructive strategies for radioulnar dissociation: a biomechanical study. J Orthop Trauma 1995; 9 (6) 516-522
- 13 Skahen III JR, Palmer AK, Werner FW, Fortino MD. Reconstruction of the interosseous membrane of the forearm in cadavers. J Hand Surg Am 1997; 22 (6) 986-994
- 14 Stabile KJ, Pfaeffle J, Saris I, Li ZM, Tomaino MM. Structural properties of reconstruction constructs for the interosseous ligament of the forearm. J Hand Surg Am 2005; 30 (2) 312-318
- 15 Tejwani SG, Markolf KL, Benhaim P. Graft reconstruction of the interosseous membrane in conjunction with metallic radial head replacement: a cadaveric study. J Hand Surg Am 2005; 30 (2) 335-342
- 16 Tejwani SG, Markolf KL, Benhaim P. Reconstruction of the interosseous membrane of the forearm with a graft substitute: a cadaveric study. J Hand Surg Am 2005; 30 (2) 326-334
- 17 Gaspar M, Osterman A, Culp R. Short-to intermediate term outcomes following interosseous membrane reconstruction using Tightrope suture-button suspensionplasty system. American Association of Hand Surgery. http://meeting.handsurgery.org/files/2016/ePoster-Abstracts.pdf . Accessed May 10, 2016
- 18 Chandler JW, Stabile KJ, Pfaeffle HJ, Li ZM, Woo SL, Tomaino MM. Anatomic parameters for planning of interosseous ligament reconstruction using computer-assisted techniques. J Hand Surg Am 2003; 28 (1) 111-116
- 19 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
- 20 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