Kadavra önkollarında interosseöz membran ve radius başı ile ilgili biyomekanik bir çalışma

Öz

Amaç: Çalışmanın amacı interosseöz membran (IOM) ve radius başının biyomekanik özelliklerini değerlendirmek ve Essex-Lopresti yaralanmasının patomekaniğini araştırmak. Çalışma planı: Test için insan kadavralarından elde edilmiş 12 taze donmuş erişkin üst ekstremitesi seçildi. Öncelikle 12 sağlam örnek sırasıyla pronasyon, supinasyon ve nötral pozisyonlarda biyomekanik test uygulamak amacıyla bir materyal test makinasına monte edildi. Örneklere her pozisyonda önkolun uzun ekseni boyunca 30 saniye süreyle 100 N’lik aksiyel yük uygulandı. Daha sonra 12 örnek rastgele iki gruba ayrıldı. Örneklerin 6’sında radius başı rezeke edildi. Diğer 6 örnekte IOM’un ortasındaki santral bant kesildi. Grupların hepsi aynı yöntemle test edildi. Son olarak, örneklerin hepsinde radius başı ve IOM eksize edilerek biyomekanik testler yapıldı. Bulgular: Önkolun rotasyonel pozisyonu veya sadece IOM’un kesilmesinin longitüdinal kayma üzerinde etkisi olmadı. Radius başının rezeksiyonundan sonra radiustaki longitüdinal kayma anlamlı oranda arttı. IOM’un kesilmesinin radiusun kompresif katılığı üzerinde etkisi olmadı. Bununla birlikte, radiusun kompresif katılığı radius başının rezeksiyonundan sonra anlamlı oranda azaldı. Çıkarımlar: Essex-Lopresti yaralanmasının en önemli nedeni IOM yaralanması ile birlikte görülen radius başı kırığı idi ve burada radius başı kırığı temel faktördü. Radius başının rezeksiyonu sonrasında önkolun longitüdinal stabilitesini koruyan en önemli yapının ise IOM olduğu saptandı.

Anahtar Kelimeler

• Biyomekanik; Essex-Lopresti yaralanması; interosseöz membran; önkol; radius başı.

A biomechanical study on the interosseous membrane and radial head in cadaveric forearms

Öz

Objective: Our aim was to evaluate the biomechanical properties of the interosseous membrane (IOM) and radial head and investigate the pathomechanics of the Essex-Lopresti injury.
Methods: Twelve adult fresh frozen upper limbs of human cadavers were chosen for test. First, the 12 intact specimens were mounted onto a materials testing machine to carry out biomechanical tests in pronation, supination and neutral positions, respectively. An axial load of 100 N was applied along the longitudinal axis of the forearm for 30 seconds in each position. Then, the twelve specimens were randomly divided into two groups. The radial head was resected in 6 specimens. And the central band of IOM was severed in another 6 specimens. Each group was tested by the same method. Finally, both the radial head and the IOM were excised in all specimens and biomechanical tests were performed.
Results: The rotational position of the forearm or simple severance of the IOM had no effect on longitudinal displacement. The radial longitudinal displacement increased significantly after resection of the radial head. The severance of the IOM had no effect on compressive stiffness of the radius. However, compressive stiffness of the radius decreased significantly after resection of the radial head.
Conclusion: The radial head fracture combined with the IOM injury was the most important cause of the Essex-Lopresti injury, and the radial head fracture was the major factor. The IOM was the major structure to maintain the longitudinal stability of the forearm after resection of the radial head. 

Anahtar Kelimeler

• Biomechanical
• Essex-Lopresti injury
• forearm
• interosseous membrane
• radial head

Kaynakça

1. Skahen JR 3rd, Palmer AK, Werner FW, Fortino MD. The interosseous membrane of the forearm: anatomy and func- tion. J Hand Surg Am 1997;22:981-5.
2. Levin PD. Fracture of the radial head with dislocation of the distal radio-ulnar joint: case report. Treatment by prosthetic replacement of the radial head. J Bone Joint Surg Am 1973; 55:837-40.
3. Trousdale RT, Amadio PC, Cooney WP, Morrey BF. Radio- ulnar dissociation. A review of twenty cases. J Bone Joint Surg Am 1992;74:1486-97.
4. Duckworth AD, Watson BS, Will EM, Petrisor BA, Walmsley PJ, Court-Brown CM, et al. Radial shortening fol- lowing a fracture of the proximal radius. Acta Orthop 2011; 82:356-9.
5. Jungbluth P, Frangen TM, Arens S, Muhr G, Kälicke T. The undiagnosed Essex-Lopresti injury. J Bone Joint Surg Br 2006; 88:1629-33.
6. Dodds SD, Yeh PC, Slade JF 3rd. Essex-lopresti injuries. Hand Clin 2008;24:125-37.
7. Wallace AL, Walsh WR, van Rooijen M, Hughes JS, Sonnabend DH. The interosseous membrane in radio-ulnar dissociation.J Bone Joint Surg Br 1997;79:422-7.
8. Pfaeffle HJ, Stabile KJ, Li ZM, Tomaino MM. Reconstruction of the interosseous ligament restores normal forearm com- pressive load transfer in cadavers. J Hand Surg Am 2005;30: 19-25.

9. 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;30:312-8.
10. Sellman DC, Seitz WH Jr, Postak PD, Greenwald AS. Reconstructive strategies for radioulnar dissociation: a bio- mechanical study. J Orthop Trauma 1995;9:516-22.
11. 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;35:1626-32.
12. Hargadon EJ, Porter ML. The Essex-Lopresti injury: a vari- ation. J Hand Surg Br 1988;13:450-2.
13. Halls AA, Travill A. Transmission of pressures across the elbow joint. Anat Rec 1964;150:243-7.
14. Birkbeck DP, Failla JM, Hoshaw SJ, Fyhrie DP, Schaffler M. The interosseous membrane affects load distribution in the forearm. J Hand Surg Am 1997;22:975-80.
15. Markolf KL, Laney D, Yang S, Meals R, Hotchkiss R. Radioulnar load-sharing in the forearm. A study in cadavera. J Bone Joint Surg Am 1998;80:879-88.
16. Pfaeffle HJ, Fischer KJ, Manson TT, Tomaino MM, Woo SL, Herndon JH. Role of the forearm interosseous ligament: is it more than just longitudinal load transfer? J Hand Surg Am 2000;25:683-8.
17. Morrey BF, An KN, Stormont TJ. Force transmission through the radial head. J Bone Joint Surg Am 1988;70:250- 6.
18. Shepard MF, Markolf KL, Dunbar AM. Effects of radial head excision and distal radial shortening on load-sharing in cadaver forearms.J Bone Joint Surg Am 2001;83-A:92-100.
19. Hotchkiss RN, An KN, Sowa DT, Basta S, Weiland AJ. An anatomic and mechanical study of the interosseous mem- brane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg Am 1989;14:256-61.
20. Rabinowitz RS, Light TR, Havey RM, Gourineni P, Patwardhan AG, Sartori MJ, et al. The role of the interosseous membrane and triangular fibrocartilage com- plex in forearm stability. J Hand Surg Am 1994;19:385-93.
21. Manson TT, Pfaeffle HJ, Herdon JH, Tomaino MM, Fischer KJ. Forearm rotation alters interosseous ligament strain distribution. J Hand Surg Am 2000;25:1058-63.