Original Communications
The efficacy of magnetic resonance imaging and ultrasound in detecting disruptions of the forearm interosseous membrane: A cadaver study,☆☆,

https://doi.org/10.1053/jhsu.2002.32961Get rights and content

Abstract

The purpose of this study was to examine the efficacy of magnetic resonance imaging (MRI) and ultrasound (US) in determining complete disruptions of the central portion of the forearm interosseous membrane. The midportion of the forearm interosseous ligament was longitudinally incised in 19 fresh-frozen cadaver arms. The specimens were imaged with MRI and US. The MRIs were examined by a hand surgeon, a musculoskeletal radiologist, and a general radiologist, all blinded to the state of the interosseous membrane. The musculoskeletal radiologist and general radiologists read the real-time US images in a consensus fashion. Magnetic resonance imaging showed a 96% accuracy rate, a 100% positive predictive value, a 93% negative predictive value, 93% sensitivity, and 100% specificity. Kappa analysis showed substantial interobserver agreement for MRI. Ultrasound showed a 94% accuracy rate, a 94% positive predictive value, a 100% negative predictive value, 100% sensitivity, and 89% specificity. There was no statistical significance between the accuracy of MRI and US. We conclude that MRI and US imaging should both be considered when forearm interosseous membrane integrity is in question. (J Hand Surg 2002;27A:418–424. Copyright © 2002 by the American Society for Surgery of the Hand.)

Section snippets

Materials and methods

Twenty fresh-frozen cadaver upper extremities amputated above the elbow were obtained and thawed to room temperature. The cadavers ranged in age from 21 to 58 years (mean age, 51 years). The specimens were then examined via fluoroscopy for evidence of prior bony injury. One arm was excluded because of obvious prior trauma, leaving 19 specimens for study.

In each specimen, the IOM was approached dorsally using a Thompson's approach. The IOM was first visualized but not transected (Fig. 1).

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Results

In all specimens the thickened central portion of the IOM could easily be visualized by MRI (Fig. 1) before to experimental sectioning. During dissection it was noted that when the central portion of the IOM was cut, the edges immediately separated and volar forearm musculature protruded (Fig. 2).

The MRI appearance of the intact cadaveric central portion of the IOM is a thick bandlike structure obliquely extending from the radius (proximally) to the ulna (distally).7 The structure is thickest

Discussion

Acute IOM injury should be inferred by the simultaneous clinical identification of radial head fracture and distal radial ulnar joint injury. Unfortunately, the diagnosis of acute or chronic longitudinal radioulnar dissociation is often made late. In either situation the treatment is considered controversial. The anatomy, strength, and kinematics of the IOM have been described.6, 9, 10, 11 The central third of the IOM is a discrete thickening located at the midshaft level of the radius. This

References (20)

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☆☆

The views expressed in this article are those of the authors and do not reflect the official policy of the Department of Defense or other Departments of the United States Government.

Reprint requests: Peter M. Murray, MD, Department of Orthopaedic Surgery/Division of Hand and Microsurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.

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