title: Radius pull test: predictor of longitudinal forearm instability.
abstract: BACKGROUND
  Longitudinal instability of the forearm (the Essex-Lopresti lesion) following radial head excision may be difficult to detect. This cadaveric study examines a stress test that can be performed in the operating room to identify injury to the ligamentous structures of the forearm.
  
  
  METHODS
  Twelve cadaveric upper extremities were randomized into two groups and underwent radial head resection. Group 1 underwent sequential transection of the triangular fibrocartilage complex and the interosseous membrane. Group 2 underwent sequential transection of the interosseous membrane and the triangular fibrocartilage complex. Ulnar variance and radial migration were examined with use of fluoroscopy of the wrist before, during, and after the application of a 9.1-kg load via longitudinal traction on the proximal part of the radius.
  
  
  RESULTS
  Group 1 demonstrated no significant changes in proximal radial migration with load (compared with the findings after radial head resection alone) after transection of the triangular fibrocartilage complex. However, Group 2 demonstrated significant changes in proximal radial migration with load after transection of the interosseous membrane (p = 0.03; median, 3.5 mm). In both groups, transection of both the triangular fibrocartilage complex and the interosseous membrane resulted in significant changes in proximal radial migration with load (p = 0.001; median, 9.5 mm). When the load was removed, specimens were ulnar positive (median, 3.0 mm), with no specimen returning to the preload position of ulnar variance (p = 0.001).
  
  
  CONCLUSIONS
  After radial head resection, 3 mm of proximal radial migration with longitudinal traction indicated disruption of the interosseous membrane. In all specimens, proximal radial migration of > or =6 mm with load indicated gross longitudinal instability with disruption of all ligamentous structures of the forearm.
authors.affiliation: Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Box 1070, Winston-Salem, NC 27157, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Smith
authors.forename: Leah R
authors.initials: LR
authors.lastname: Urbanosky
authors.forename: Jason A
authors.initials: JA
authors.lastname: Castle
authors.forename: Julia T
authors.initials: JT
authors.lastname: Rushing
authors.forename: David S
authors.initials: DS
authors.lastname: Ruch
mesh_terms: D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000503:physiopathology; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D007593:Joint Instability / Q000175:diagnosis*; D008023:Ligaments, Articular / Q000293:injuries*; D011884:Radius / Q000293:injuries* / Q000601:surgery; D014457:Ulna / Q000293:injuries*; D000092464:Elbow Injuries