Additional ligaments, also known as accessory bands, are oriented in the same direction as the central band to complete the middle ligamentous complex of the IOM. The central tendinous portion of the IOM is obliquely oriented, forming an average angle of 20° with the longitudinal axis of the radius and 28° with the longitudinal axis of the ulna. The central band is the widest and thickest part of the IOM, representing the most important anatomic component of the membrane. The structure of the IOM includes five ligaments: central band, accessory band, distal oblique bundle, proximal oblique cord, and dorsal oblique accessory cord. The IOM plays a major role in forearm stability and allows load transfer from the radius to ulna. The forearm joint thus has two anatomical lockers (PRUJ and DRUJ) and one functional locker (MRUJ), allowing stability during pronation and supination of the forearm. Two anatomical joints: the proximal radioulnar joint (PRUJ) and distal radioulnar joint (DRUJ) One functional joint: the middle radioulnar joint (MRUJ), formed by the forearm bones and IOM The forearm acts as a single functional unit constituted of: The concept of forearm joints as described by Dumontier and Soubeyrand is a cornerstone of the full understanding of forearm injuries. Over the last two decades, anatomical and biomechanical knowledge of the forearm has greatly improved, and some traumatic injuries involving this anatomical segment can now be seen from a new perspective. This might avoid confusion in forearm fracture–dislocations nomenclature and help surgeons with detection of lesions, guiding surgical treatment. ConclusionsĪll injury patterns may be previously identified using an alphanumeric code. According to this classification, and similarly to that of the elbow, we could distinguish between simple dislocations and complex dislocations (fracture–dislocations) of the forearm joint. In addition to fracture–dislocations commonly referred to using historical eponyms (Monteggia, Galeazzi, and Essex-Lopresti), our classification system, to the best of the authors’ knowledge, allowed us to include all types of dislocation and fracture–dislocation of the forearm joint reported in literature. Furthermore, we identified a group of three-locker injuries, other than Essex-Lopresti, associated with ulnar and/or radial shaft fracture causing longitudinal instability. We detected rare patterns of two-locker injuries, sometimes referred to using improper terms of variant or equivalent types of Monteggia and Galeazzi injuries. Three historical reviews were added separately to the process. According to exclusion criteria, 44 full-text articles describing atypical forearm fracture–dislocation were included. ResultsĮighty hundred eighty-four articles were identified through PubMed, and after bibliographic research, duplication removal, and study screening, 462 articles were selected. After article retrieval, the types of forearm lesion were classified using the following numerical algorithm: proximal forearm joint 1, middle radioulnar joint 2, if concomitant radial fracture R, if concomitant interosseous membrane rupture I, if concomitant ulnar fracture U, and distal radioulnar joint 3. Essex-Lopresti injury, Monteggia and Galeazzi fracture–dislocations, and proximal and/or distal radioulnar joint dislocations were sought. MethodsĪ comprehensive search of the PubMed database was performed based on major pathological conditions involving fracture–dislocation of the forearm. In this study we systematically review the literature to identify and classify all cases of forearm joint injury pattern according to the forearm joint and three-locker concepts. Uncommon variants and rare traumatic patterns of forearm fracture–dislocations have sometimes been reported in literature. Monteggia, Galeazzi, and Essex-Lopresti injuries are the most common types of fracture–dislocation of the forearm.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |