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Reconstruction of the interosseous membrane has the potential to re-establish a normal loading pattern through the forearm and enhance stability after an Essex-Lopresti lesion. The aim of our study was to assess the capacity of three different techniques, which all use a regionally harvested autograft, to restore longitudinal stability. Simulation of the Essex-Lopresti lesion was done by excising the radial head and sectioning the interosseous membrane in seven cadaveric specimens. Each technique was used in each specimen consecutively, using the pronator teres, the brachioradialis and the flexor carpi radialis tendons, respectively. The specimens were submitted to mechanical testing by applying proximally migratory forces to the radius and radioulnar displacement was assessed fluroscopically at wrist level. The pronator teres tendon achieved the greatest reduction (94% correction with respect to the intact interosseous membrane/radial head out state, followed by brachioradialis (92%) and flexor carpi radialis (85%). However, no statistically significant differences in displacement data or strength were detected between the techniques.

Reconstruction of the central band of the interosseous membrane is an emerging procedure implemented in the treatment of longitudinal radioulnar dissociation (LRUD), usually in its chronic setting, after Essex-Lopresti injuries of the forearm.There are no sufficient clinical data to support reconstruction of the central band of the interosseous membrane in acute LRUD injuries.Clinical and cadaveric studies comparing autografts (palmaris longus, flexor carpi radialis and bone-patellar-bone), allografts (Achilles tendon) and synthetic ligaments have not shown superiority of one technique versus another; however, they have shown special concerns with respect to the use of synthetic grafts.Latrogenic fracture, decrease of rotational range of movement, iatrogenic nerve injury (superficial radial and median nerve), donor site morbidity with autografts and recurrent instability are the complications reported in literature after interosseous membrane reconstruction. Cite this article: EFORT Open Rev 2019;4:143-150. DOI: 10.1302/2058-5241.4.180072., Competing Interests: ICMJE Conflict of interest statement: The author declares no conflict of interest relevant to this work.

Longitudinal stability of the forearm is mainly provided by three structures: the radiocapitellar contact, which acts as the primary stabilizer, the central band of the interosseous ligamentous complex (IOLC) and the intact triangular fibrocartilage complex (TFCC). In an Essex-Lopresti lesion the forearm becomes fully destabilized, since all of these three components are injured. Fixation or replacement of the radial head with a metallic prosthesis along with repair of the TFCC and stabilization of the distal radioulnar joint (DRUJ) are well-established treatment goals. However the reconstruction of the central band of the IOLC remains to some extent controversial. The authors believe that the reconstruction of the central band, particularly in active patients, is crucial in order to restore normal load distribution through the forearm, thus ensuring both transverse and longitudinal stability. In this article, we present a case with an Essex-Lopresti lesion, which was effectively treated acutely with restoration of all three components of the injury (radial head prosthesis, DRUJ repair and reconstruction of the central band of the IOLC). A novel technique by rerouting the brachioradialis tendon is described in detail.

This report updates information on wrist dart-throwing (DT) motion, based on the most recent research published on the kinematics, kinetics, and clinical applications of DT motion. A wide range of DT planes exists. "Pure" DT motion is done along an oblique plane that intercepts the coronal and sagittal planes at the zero position, and occurs almost exclusively at the midcarpal joint with near zero scaphoid and lunate motion. "Functional" DT motion such as a hammering is done along an oblique plane that is almost parallel to the pure DT plane, but that has an offset toward the dorsal side. Functional DT rotation has greater scaphoid and lunate motion compared with pure DT motion. Midcarpal arthrodesis adversely affects DT motion compared with radiocarpal arthrodesis. During a DT motion, the mean and peak tendon forces of the flexor carpi ulnaris and the extensor carpi radialis longus were the greatest among wrist motors. By performing a task along the plane of DT motion, the scapholunate (SL) joint was stable and SL ligament elongation was minimal in healthy subjects. However, a more recent study of patients with SL dissociation revealed that DT exercises applied tensile forces on the SL ligament and induced an SL gap., (Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: Repair of the dorsal component of the scapholunate ligament alone is the usual surgical treatment for scapholunate injuries. Recent literature has suggested that additionally repairing the palmar component of the scapholunate ligament leads to improved and lasting clinical outcomes. The aim of this study was to determine the biomechanical properties of both portions of scapholunate ligaments derived from the same wrist and compare them with the whole scapholunate ligament. The goal was to further elucidate the importance of the palmar portion of the scapholunate ligament from a biomechanical perspective., Methods: Scapholunate ligaments and their components were harvested from the same fresh frozen cadaveric wrists. Force at failure and stiffness were measured., Findings: The mean maximum loads to failure for the entire scapholunate ligament, dοrsal and palmar portions were found to be 147 (SD 54)N, 83 (SD 18)N and 86 (SD 16)N respectively. No statistical difference was found between the mean maximum load and stiffness for palmar and dorsal components (P=0.05). Mean maximum load and stiffness, of the intermediate portion, were 36 (SD 15)N and 25 (SD 23)N/mm., Interpretation: Our biomechanical findings on the dorsal and palmar portions of the scapholunate ligament suggest that each portion contributes approximately 50% to the whole ligament tensile force. These results appear to agree with other reports about the stabilizing role of the palmar portion of the scapholunate ligament and suggest that the palmar portion of the ligament should be considered for surgical repair., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The Scapholunate (S-L) and Lunotriquetrum (L-Tr) ligaments have been extensively studied in the literature. A wide range of measurements has been reported for ultimate load and stiffness with different mechanical protocols. In this study, we examined the mechanical properties of both ligaments harvested from the same wrist. Fifteen fresh cadaver wrists were used to harvest eight S-L and four L-Tr. Testing was performed in quasi-static loading in a well defined direction for each ligament system. The ultimate load for S-L was 68-210 N with a mean value of 147 ± 54 N and a stiffness of 35.7 ± 9.6 N/mm. For L-Tr the ultimate load was 122-179 N with a mean value of 150 ± 24 N and a stiffness of 192 ± 60 N/mm. The two ligaments had nearly the same ultimate load, but the L-Tr had a higher stiffness (p = 0.05). These findings could be useful to assess the appropriate autologous autografts for reconstruction of the S-L and L-Tr., (Copyright © 2010 Orthopaedic Research Society.)

The dart-throwing motion (DTM) plane can be defined as a plane in which wrist functional oblique motion occurs, specifically from radial extension to ulnar flexion. Most activities of daily living are performed using a DTM. The DTM utilizes the midcarpal joint to a great extent. Scaphotrapezio-trapezoidal anatomy and kinematics may be important factors that cause a DTM to be a more stable and controlled motion. During a DTM, there is less scaphoid and lunate motion than during pure flexion-extension or radioulnar deviation. Clinically, a DTM at the plane approximately 30 degrees to 45 degrees from the sagittal plane allows continued functional wrist motion while minimizing radiocarpal motion when needed for rehabilitation.

The objective of this study was to determine whether hardness of the superficial layer is a useful parameter to characterise cartilage produced by periosteal neochondrogenesis, using rabbit knee lesions as a model. A cartilage defect was created in the right hind knee of anesthetised young adult rabbits, and the defect was then covered with an autologous periosteal graft. At one and eight months postsurgery, rabbits were euthanised, and the articular cartilage lesion sites were evaluated for the histological parameters in a modified O'Driscoll scale, which is the current 'gold standard' for new cartilage properties. In addition, a static indentation test was performed, using a Shore-A sclerometer to measure surface hardness of the new cartilage. The hardness values had a statistically significant, positive correlation with the O'Driscoll parameters. This combination of a biomechanical measure and the O'Driscoll scale provided a more definitive indicator of graft quality. The results suggest that a hardness test with some type of sclerometer should be included in the functional characterisation of all engineered or grafted neocartilage.

We report an iatrogenic neurovascular injury during hip arthroplasty surgery. During insertion of a threaded titanium cup into a dysplastic acetabulum (lack of anterior wall), both the common femoral artery and nerve were crushed. It is therefore recommended that, if the soft tissues are exposed and can interfere with the instruments, inserts that require rotation should not be selected to be placed in the acetabulum. To the best of our knowledge, such a mechanism of injury has never been reported.