Distal interosseous membrane of the forearm: anatomy, biomechanics, diagnostics

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Abstract


Relevance. Recent studies show that even with damage to the structures of the triangular fibrocartilaginous complex (primary stabilizer), instability of the distal ray-elbow joint does not develop in some cases. Studies carried out by a number of authors prove that the distal interosseous membrane of the forearm can influence the stability of the joint and be a secondary stabilizer for it.

Aim of the study. To study the variability in the structure of the distal interosseous membrane of the forearm using anatomical material and determine the effect of the distal interosseous membrane on the stability of the distal ray-elbow joint. Using ultrasound to determine the variability of the structure of the distal interosseous membrane of the forearm.

Materials and methods. Material for our study was 10 pairs of anatomical specimens of the upper extremities. The functional viability was assessed by passive rotation of the anatomical material of the forearm. Changes in the tension of the distal interosseous membrane, its additional formations and the capsule of the distal ray-elbow joint were observed. Ultrasound was chosen as an instrumental method for visualizing the distal interosseous membrane of the forearm and its structures. In the course of this work, 30 volunteers of both sexes and different ages were examined. The study was carried out: maximum pronation (position of the sensor back) and maximum supination (position of the sensor palmar).

Results. In the course of the anatomical study, we determined that in 6 pairs of anatomical material, the distal interosseous membrane is a thin transparent connective tissue structure. No additional formations in the form of thickening were found. In 4 pairs of preparations, which amounted to 40% of the total amount in the distal interosseous membrane, there were additional formations in the form of thickening of the membrane — this is the distal oblique bundle and the distal ray-the ulnar tract. During the functional study, it was revealed that during pronation of the forearm, the distal membrane and dorsal capsule are stretched, which in turn holds the head of the ulna in the sigmoid notch of the radius. After conducting ultrasound, we determined the variability in the structure of the distal interosseous membrane of the forearm. The distal oblique bundle is visualized as a linear hyperechoic formation. Of the 30 surveyed, this formation was identified in 13 women (92.8%) and 1 man (7.1%), which in percentage terms was 43%.

Conclusion. After conducting anatomical examination, we determined the variability in the structure of the distal interosseous membrane of the forearm in the form of the presence of thickenings — the distal oblique bundle and the distal ray-ulnar tract, and determined the effect of these structures on the stability of the distal ray-elbow joint. An ultrasound scan also identified the features in the structure of the distal interosseous membrane in the form of — hyperechoic formation.


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About the authors

Igor O. Golubev

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: iog305@mail.ru

Russian Federation, Moscow

MD, PhD, Dr. Sci. (Med.), Head of the department of microsurgery and hand injury

Natalia Yu. Matveeva

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: nymatveeva@smail.com

Russian Federation, Moscow

MD, Cand. Sci. (Med.), ultrasound diagnostics doctor

Mikhail L. Maksarov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: potapich85@mail.ru

Russian Federation, Moscow

graduate student

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Distal oblique bundle (indicated by arrows): a — in the distal interosseous membrane; b — absent in the distal interosseous membrane [14]. R — radius, U — ulna

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2.
Fig. 2. Types of structure of the distal interosseous membrane of the forearm: a — the usual membranous type of structure; b — there is a thickening in the membrane in the form of a bundle; c — there is a thickening in the membrane — proximally it looks like a bundle, and distally — fan-shaped; d — diffuse type of structure (the membrane is thickened throughout) [12]

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3.
Fig. 3. Distal radioulnar tract running parallel to the distal oblique bundle (indicated by the arrow) [13]. R — radius, U — ulna

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4.
Fig. 4. The usual type of structure of the distal interosseous membrane of the forearm without thickening

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5.
Fig. 5. Distal oblique bundle with distal interosseous membrane of the forearm (arrow)

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6.
Fig. 6. Distal oblique bundle in the distal interosseous membrane of the forearm — fan-shaped type of structure (shown by an arrow)

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7.
Fig. 7. Presence in the distal interosseous membrane of the forearm of the distal oblique bundle (1) and the distal radioulnar tract (2)

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8.
Fig. 8. Ultrasound image of the distal part of the interosseous membrane of the forearm — the distal oblique bundle is absent.

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9.
Fig. 9. Ultrasound image of the distal interosseous membrane of the forearm — the distal oblique bundle is present.

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