Clinical and Non-Clinical Aspects of Distal Radioulnar Joint Instability

Untreated distal radioulnar joint (DRUJ) injuries can give rise to long lasting complaints. Although common, diagnosis and treatment of DRUJ injuries remains a challenge. The articulating anatomy of the distal radius and ulna, among others, enables an extensive range of forearm pronosupination movements. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. These structures transmit the load and prevent the DRUJ from luxation during movement. Several clinical tests have been suggested to determine static or dynamic DRUJ stability, but their predictive value is unclear. Radiologic evaluation of DRUJ instability begins with conventional radiographs in anterioposterior and true lateral view. If not conclusive, CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability. DRUJ instability may remain asymptomatic. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment should consist of restoration of osseous and ligamenteous anatomy. If not successful, salvage procedures can be performed to regain stability

Longitudinal Instability of the Forearm: Anatomy, Biomechanics, and Treatment Considerations

Longitudinal instability of the forearm (the Essex-Lopresti injury, radioulnar dissociation) is uncommon and is often missed in the initial assessment of a patient with a radial head fracture. The present review outlines the anatomy and biomechanics of the forearm unit, as well as the current means of diagnosis and the range of treatment options avaailable for this challenging problem.</p

Kinematics and biomechanics in normal and replacement elbow

The biomechanics of normal elbow is of primary importance because its comprehension can help the understanding of the functionality of the whole upper limb. The elbow represents a connecting point between the arm and the forearm contributing to modify the relationship between these segments to correctly position the hand in the three-dimensional space. In the following chapter, we will discuss which are the kinematic requirements needed to perform activities of daily living, as well as the impact of muscular actions and external forces on elbow. The final part of the chapter will focus on the role of biomechanics in elbow arthroplasty surgery and its implication in real-life settings

Longitudinale Instabilität des Unterarms

The Essex Lopresti lesion is a rare triad of injury to the radial head, interosseous membrane of the forearm and distal radio-ulnar joint, which results in longitudinal instability of the radius. If unrecognized this leads to chronic pain and disability which is difficult to salvage. Early recognition and appropriate treatment is therefore desirable to prevent long-term problems. The aim of this article is to review the pathoanatomy of longitudinal radius instability and use the existing literature and authors’ experience to provide recommendations for recognition and treatment of acute and chronic forearm instability, including description of the author’s technique for interosseous membrane reconstruction.</p