useful ! you need one Hey! Im trying to pass the potatoes! .Remember, my forearms are just as useless as yours!
And it can be so useful
that it can compensate for severe loss of function of the hand
Amaranth S et al. Krukenberg operation: The "lobster claw" for traumatic amputation of the left hand. 2014
This is because the forearm is
a joint (an association of joints) That allows two different bones (radius and ulna) to move one aroud the other
The forearm biomechanics
is about pronosupination A joint: The association of three joints A mouvement: rotation of the forearm An axis: starting at the radial head and ending at the ulnar head Motors: muscles for pronation and supination
PRUJ and DRUJ are wellknow synovial joints
For teaching purposes, CG. HAGERT used to removed the middle forearm to explain forearm rotation
Proximal ulna
Distal radius
Proximal radius
Distal ulna
The axis of rotation
Each joint has its own axis of rotation Which is identical for the three joints
Both PRUJ and DRUJ
are pivot joint (trochoid)
The forearm should be regarded as the
third joint: The middle radioulnar joint
Forearm rotation is not possible is
the third joint is not functional +++ LaStayo PC, Lee MJ (2006) The forearm complex: anatomy, biomechanics and clinical considerations. J Hand Ther 19:137144
As any joint, it has bony structures
Whose shape and alignment are important for motion Ulnar shaft, almost linear Radial shaft has two curvatures (supinator proximal, pronator distal) Failure to restore the normal radial bow to within 4% to 5% of the contralateral forearm has been associated with greater than 20% loss of forearm rotation. Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg 1992;74A:10681078.
and ligaments
The Interosseous membrane : thickness
2,18 mm
Assemblage nucleus
Two type of fibers according to their
direction forming a criss-cross system Most of them originates from the assemblage nucleus 8 cm from elbow joint Poitevin LA (2001) Anatomy and biomechanics of the interosseous membrane: its importance in the longitudinal stability of the forearm. Hand Clin 17:97110
Like most joints it has fibers that we do not
understand their role at the moment Oblique cord (Weitbrechts ligament), thick structure ( 1-3 mm) Proximal band (inconstant - 2,87 +/- 0,71 mm thickness)
Posterior view
1,1 to 2,6 cm 2,7-3,5 cm
57%
7,7 cm
25 13,2 cm
32% Anterior view
Distinct patterns Central band: 1,3 mm thick / 1 cm large Accessory bands on either sides: 1 mm thick
K. Noda et al. JHS 2009; 34A: 415-422
Distal membranous portion
Presence of a distal oblique bundle in 12/30 specimens Distal fibers blend with the DRUJ (even TFCC)
K. Noda et al. JHS 2009; 34A: 415-422
Rigidity:
13,1 +/- 3,0 N/mm
Elastic modulus: 608,1 +/- 160,2 mPa
Elasticity:
9,0 +/- 2,0 %
Composition Prolongation of the periosteum of ulna and radius Collagen (60-90%) and elastin
Proximal and distal part
Central band (ligament)
Intermediate structure between a fascia and a ligament Microvascularization which diminish with time
Central band
Indirect physiological role
Insertions for some muscles of the forearm (FPL, FDP, APL, EIP, EPL) Limits one of the boarder of the compartment
Direct physiological role
Only known for the central band Transmission of axial and transversal loads
Its role in transverse stability
Convergent transverse forces are controlled by bony architecture Radioulnar abutment can be seen after radial head or ulnar head resection
Its role in transverse stability
Loads tend to put the two bones apart The IOM has a transverse vector that participates to control the divergence However it is much less important that the PRUJ and DRUJ who are the main stabilizers
Its role in transverse
stability However in severe Monteggias or Galeazzis fracture, the IOM is involved and contribute to the instability of such fractures DRUJ dislocation cannot occur without IOM disruption
In full-pronation, once the radial
head is removed, you cannot laterally translate the radial head if the IOM is intact Validated if > 5,5 mm in supination (Kochei, JHS 2015s)
and a pneumatic device to !grip" the metacarpals (Fig.
nd device to k-wire !grip" the metacarpals (Fig.ulna, 1).a Apneumatic transverse 2 mm passed across the .perpendicular A transverse to 2 mm k-wire passed the ulna, the olecranon bolt,across and rested on two erpendicular to the olecranon bolt, and rested on two further 5mm bolts attached to the frame to prevent rotaurther 5mm bolts attached to the frame to prevent rotation of the ulna. on of the ulna.
displacement shown as a displacement versus time g
displacement shown a displacement versus by time graph on the PC. The as DVRT was calibrated the manu on the PC.and Thethe DVRT was calibrated by the manufacturer readings were in millimetres. The s turer and the readings were in millimetres. The strain was calculated as the change in length over the ori was calculated as the change in length over the original length of the DVRT at the start of a set of reading length of the DVRT at the start of a set of readings.
Longitudinal stability
g.Fig. 1. Specimen mounted on frame. Hand passed through slot on 2. DVRT sutured to thetocentral band of the ofinterosseous 1. Specimen mounted on frame. Hand passed through slot on Fig. Fig. 2. DVRT sutured the central band the interos tating device andand gripped around metacarpals. membrane. rotating device gripped around metacarpals. membrane.
Longitudinal stability At the wrist, about 80% of axial loads go through the radius At the elbow, ulna carries about 60% of axial loads Transfer of loads is made possible by the orientation of the fibers of the interosseous membrane
Load transfer varies according to:
Frontal inclination of the wrist, Wrist positioning in flexion or extension, Forearm rotation Elbow inclination in the frontal plane
Radial head resection
Allows proximal migration of 7 mm, even if soft-tissues are intact IOM is responsible for 71% of the stiffness and carries 90% of axial loads
TFCC or IOM section
Combined section + radial
head resection
Major displacement
Elbow:
Forearm :
Wrist :
Radius > annular ligament
Interosseous membrane TFCC
Elements of longitudinal stability
Anatomical factors responsible
for proximal radius migration Biceps Humero-carpal muscles (FCR, FCU, FDP, FCS, ECRL, ECRB, EDC) Deep posterior muscles
Take home message
The forearm should be considered as a functional unit made of three consecutive joints which function is to allow forearm rotation The IOM is part of the middle radio-ulnar joint Although incompletely understood, its major role is to provide longitudinal stability
