Papel de la banda oblicua distal del antebrazo en la estabilidad de la articulación radiocubital distal estudio biomecánico y clínico de técnica quirúrgica de reconstrucción con autoinjerto de extensor carpi radialis longus

Abstract

INTRODUCTION The distal radioulnar joint instability is a complex problem and multiple surgical techniques have been developed to restore joint function without sacrificing strength or mobility of the wrist and hand. The distal oblique bundle of the interosseous membrane of the forearm has gained importance as a joint stabilizer since its description in 2009 to the point that, in recent years, several surgical techniques have appeared that seek its reconstruction. The study of the function of the distal oblique bundle and its reconstruction is a current topic in hand and wrist surgery. METHODS This study presents a biomechanical study on three cadaveric pieces to examine the stability provided by the distal oblique bundle. In addition, this study describes a surgical technique for reconstruction of the distal oblique bundle with extensor carpi radialis longus autograft and its clinical and functional outcomes in twelve operated patients. RESULTS All of cadaveric pieces showed clear instability when the distal oblique bundle was sectioned and, in turn, stability results similar to normal were obtained when the bundle was reconstructed. The triangular fibrocartilage complex reparation did not show better results. One year after surgery, the patients showed positive results in terms of strength and mobility. Residual pain was low, complications were almost non-existent and clinical and subjective instability disappeared. CONCLUSIONS The distal oblique bundle acts as a primary stabilizer of the radioulnar distal joint. The proposed surgical technique is shown to be safe and effective in stabilize the joint and has good clinical results.