nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

24.10.2020 | Original Article

Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study

verfasst von: Cyril Guetari, Maud Creze, Marc Soubeyrand

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The proximal radioulnar joint (PRUJ) and the radiocapitellar joint may be destabilized after trauma. Different techniques for stabilization of PRUJ have been proposed, but none of them can stabilize the radiocapitellar joint at the same time. We propose a ligamentoplasty to stabilize the radial head at these two joints by reconstructing the radial head annular ligament and the lateral collateral ulnar ligament (LCUL) with a single graft (palmaris longus or gracilis tendon of the knee).

Methods

Fifteen cadaveric upper limbs were used to compare the stabilization obtained by performing our ligamentoplasty with the palmaris longus or the gracilis tendon. For each technique, the stabilization obtained was evaluated by measuring the displacement of the radial head in the anterior, lateral and posterior directions when a force of 1 N was applied in maximum supination, neutral rotation and maximum pronation. We also evaluated whether this technique could damage the ulnar nerve or the posterior interosseous nerve by dissecting them and whether it could limit the range of rotation of the forearm.

Results

Our ligamentoplasty enables to restore PRUJ stability equivalent to the intact ligament condition. The palmaris longus was inconstant (13/15) and too short to allow concomitant reconstruction of the LCUL (except in one case). No nerve damage was found during the dissection, and the range of rotation of the forearm was not limited by the ligamentoplasty. We also report a clinical case with an excellent result and without complications.

Conclusion

This ligamentoplasty we have described makes it possible to stabilize the radial head with respect to the radial notch of the ulna and with respect to the capitellum of the humerus. The gracilis tendon is more suitable than the palmaris longus because of its constant presence and length. A clinical series is now necessary to better evaluate this technique.

Green JB, Zelouf DS (2009) Forearm instability. J Hand Surg Am 34(5):953–961. https://doi.org/10.1016/j.jhsa.2009.03.018CrossRefPubMed

McGlinn EP, Sebastin SJ, Chung KC (2013) A historical perspective on the essex-lopresti injury. J Hand Surg Am 38(8):1599–1606. https://doi.org/10.1016/j.jhsa.2013.04.031CrossRefPubMedPubMedCentral

Camp CL, Fu M, Jahandar H, Desai VS, Sinatro AM, Altchek DW, Dines JS (2019) The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments. J Shoulder Elb Surg 28(4):665–670. https://doi.org/10.1016/j.jse.2018.09.019CrossRef

Otayek S, Tayeb AE, Assabah B, Viard B, Dayan R, Lazure T, Soubeyrand M (2016) Squared ligament of the elbow: anatomy and contribution to forearm stability. Surg Radiol Anat 38(2):237–244. https://doi.org/10.1007/s00276-015-1539-zCrossRefPubMed

Otayek S, Tayeb AA, Assabah B, Viard B, Dayan R, Lazure T, Soubeyrand M (2015) Squared ligament of the elbow: anatomy and contribution to forearm stability. Surg Radiol Anat. https://doi.org/10.1007/s00276-015-1539-zCrossRefPubMed

Hayami N, Omokawa S, Iida A, Kraisarin J, Moritomo H, Mahakkanukrauh P, Shimizu T, Kawamura K, Tanaka Y (2017) Biomechanical study of isolated radial head dislocation. BMC Musculoskelet Disord 18(1):470. https://doi.org/10.1186/s12891-017-1829-1CrossRefPubMedPubMedCentral

Soubeyrand M, Lafont C, De Georges R, Dumontier C (2007) Traumatic pathology of antibrachial interosseous membrane of forearm. Chir Main 26(6):255–277. https://doi.org/10.1016/j.main.2007.09.004CrossRefPubMed

Loeffler BJ, Green JB, Zelouf DS (2014) Forearm instability. J Hand Surg Am 39(1):156–167. https://doi.org/10.1016/j.jhsa.2013.07.010CrossRefPubMed

Leung YF, Ip SP, Ip WY, Kam WL, Wai YL (2005) The crisscross injury mechanism in forearm injuries. Arch Orthop Trauma Surg 125(5):298–303. https://doi.org/10.1007/s00402-005-0805-7CrossRefPubMed

10.

Bryan RS (1971) Monteggia fracture of the forearm. J Trauma 11(12):992–998CrossRef

11.

Cheung EV, Yao J (2009) Monteggia fracture-dislocation associated with proximal and distal radioulnar joint instability. a case report. J Bone Jt Surg Am 91(4):950–954. https://doi.org/10.2106/JBJS.H.00269CrossRef

12.

Deshpande S, O’Doherty D (2001) Type I monteggia fracture dislocation associated with ipsilateral distal radial epiphyseal injury. J Orthop Trauma 15(5):373–375CrossRef

13.

Rehim SA, Maynard MA, Sebastin SJ, Chung KC (2014) Monteggia fracture dislocations: a historical review. J Hand Surg Am 39(7):1384–1394. https://doi.org/10.1016/j.jhsa.2014.02.024CrossRefPubMedPubMedCentral

14.

Bell Tawse AJ (1965) The treatment of malunited anterior monteggia fractures in children. J Bone Jt Surg Br 47(4):718–723CrossRef

15.

Cappellino A, Wolfe SW, Marsh JS (1998) Use of a modified Bell Tawse procedure for chronic acquired dislocation of the radial head. J Pediatr Orthop 18(3):410–414PubMed

16.

Oner FC, Diepstraten AF (1993) Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Jt Surg Br 75(4):577–581CrossRef

17.

Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, Kato H (2009) Long-term clinical and radiographic outcomes after open reduction for missed monteggia fracture-dislocations in children. J Bone Jt Surg Am 91(6):1394–1404. https://doi.org/10.2106/JBJS.H.00644CrossRef

18.

Wang MN, Chang WN (2006) Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma 20(1):1–5CrossRef

19.

Ghinea CA, Gavriliu S, Georgescu I, Vlad C, Japie E, Parvan A, Ghita R (2013) Burnei’s technique in the treatment of radial head displacement; innovative surgery. study on two cases. J Med Life 6(1):26–33PubMedPubMedCentral

20.

Raouf HA, Kader GA, Jaradat A, Dharap A, Fadel R, Salem AH (2013) Frequency of palmaris longus absence and its association with other anatomical variations in the Egyptian population. Clin Anat 26(5):572–577. https://doi.org/10.1002/ca.22186CrossRefPubMed

21.

Yong MW, Yusof N, Rampal L, Arumugam M (2017) Prevalence of absence of palmaris longus and its association with gender, hand dominance and absence of FDS tendon to little finger among Malay population. J Hand Surg Asian Pac 22(4):484–489. https://doi.org/10.1142/S021881041750054XCrossRef

22.

Cinque ME, Schickendantz M, Frangiamore S (2020) Review of anatomy of the medial ulnar collateral ligament complex of the elbow. Curr Rev Musculoskelet Med 13(1):96–102. https://doi.org/10.1007/s12178-020-09609-zCrossRefPubMedPubMedCentral

23.

Soubeyrand M, Ciais G, Wassermann V, Kalouche I, Biau D, Dumontier C, Gagey O (2011) The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane. J Bone Jt Surg Br 93(10):1389–1394. https://doi.org/10.1302/0301-620X.93B10.26590CrossRef

24.

Soubeyrand M, Wassermann V, Hirsch C, Oberlin C, Gagey O, Dumontier C (2011) The middle radioulnar joint and triarticular forearm complex. J Hand Surg Eur 36(6):447–454. https://doi.org/10.1177/1753193410396976CrossRef

25.

Adams JE (2017) Forearm instability: anatomy, biomechanics, and treatment options. J Hand Surg Am 42(1):47–52. https://doi.org/10.1016/j.jhsa.2016.10.017CrossRefPubMed

26.

Galik K, Baratz ME, Butler AL, Dougherty J, Cohen MS, Miller MC (2007) The effect of the annular ligament on kinematics of the radial head. J Hand Surg [Am] 32(8):1218–1224. https://doi.org/10.1016/j.jhsa.2007.06.008CrossRef

27.

Biewener A, Bischoff F, Rischke T, Tille E, Nimtschke U, Kasten P, Schaser KD, Nowotny J (2019) Instability of the proximal radioulnar joint in monteggia fractures-an experimental study. J Orthop Surg Res 14(1):392. https://doi.org/10.1186/s13018-019-1367-7CrossRefPubMedPubMedCentral

28.

David-West KS, Wilson NI, Sherlock DA, Bennet GC (2005) Missed monteggia injuries. Injury 36(10):1206–1209. https://doi.org/10.1016/j.injury.2004.12.033CrossRefPubMed

29.

Tosun B, Selek O, Buluc L, Memisoglu K (2008) Chronic post-traumatic radial head dislocation associated with dissociation of distal radio-ulnar joint: a case report. Arch Orthop Trauma Surg 128(7):669–671. https://doi.org/10.1007/s00402-007-0456-yCrossRefPubMed

30.

Agarwal A, Pawar I (2017) Neglected type I monteggia fracture dislocation in adult. J Clin Diagn Res 11(8):RD01–RD02. https://doi.org/10.7860/JCDR/2017/28250.10468CrossRefPubMedPubMedCentral

31.

Chen HY, Wu KW, Dong ZR, Huang SC, Kuo KN, Wang TM (2018) The treatment of chronic radial head dislocation in monteggia fracture without annular ligament reconstruction. Int Orthop 42(9):2165–2172. https://doi.org/10.1007/s00264-018-3943-6CrossRefPubMed

32.

Hirayama T, Takemitsu Y, Yagihara K, Mikita A (1987) Operation for chronic dislocation of the radial head in children. reduction by osteotomy of the ulna. J Bone Jt Surg Br 69(4):639–642CrossRef

33.

Datta T, Chatterjee N, Pal AK, Das SK (2014) Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. J Clin Diagn Res 8(6):LC01-04. https://doi.org/10.7860/JCDR/2014/9891.4409CrossRefPubMedPubMedCentral

34.

Liao S, Pan J, Lin H, Xu Y, Lu R, Wu J, Zhao M, Chen H, Cai M, Ding X, Zhao J (2019) A new approach for surgical treatment of chronic monteggia fracture in children. Injury 50(6):1237–1241. https://doi.org/10.1016/j.injury.2019.04.017CrossRefPubMed

35.

Boyd HB, Boals JC (1969) The monteggia lesion. a review of 159 cases. Clin Orthop Relat Res 66:94–100CrossRef

36.

Bhaskar A (2009) Missed monteggia fracture in children: is annular ligament reconstruction always required? Indian J Orthop 43(4):389–395. https://doi.org/10.4103/0019-5413.55978CrossRefPubMedPubMedCentral

37.

Lloyd-Roberts GC, Bucknill TM (1977) Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Jt Surg Br 59-B(4):402–407CrossRef

38.

Pari C, Puzzo A, Paderni S, Belluati A (2018) Annular ligament repair using allograft for the treatment of chronic radial head dislocation: a case report. Acta Biomed 90(1):154–157PubMed

39.

Yammine K, Eric M (2020) Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. a systematic review of cadaveric studies. Surg Radiol Anat 42(3):259–267. https://doi.org/10.1007/s00276-019-02381-xCrossRefPubMed

Titel: Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study
verfasst von: Cyril Guetari
Maud Creze
Marc Soubeyrand
Publikationsdatum: 24.10.2020
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 4/2021
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-020-02815-y

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study

Abstract

Purpose

Methods

Results

Conclusion

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

TEP mit Roboterhilfe führt nicht zu größerer Zufriedenheit

Lever-Sign-Test hilft beim Verdacht auf Kreuzbandriss

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

Update Orthopädie und Unfallchirurgie

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusion

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2021

Treatment of aseptic nonunion after medial opening-wedge high tibial osteotomy

A comparative prospective study between stemmed versus an unstemmed tibial component in total knee arthroplasty in obese patients

No difference in patient compliance between full-strength versus low-dose aspirin for VTE prophylaxis following total hip and total knee replacement

Osteomyelitis of the femur effectively treated with medulloscopy debridement: a case report

Risk factors for dislocation after bipolar hemiarthroplasty: a retrospective case–control study of patients with CT data

Hypodermic needle fixation without fluoroscopy versus k-wire fixation with fluoroscopy for distal phalangeal fractures: a comparative study

Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

TEP mit Roboterhilfe führt nicht zu größerer Zufriedenheit

Lever-Sign-Test hilft beim Verdacht auf Kreuzbandriss

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

Update Orthopädie und Unfallchirurgie