title: Interosseous membrane reconstruction with a suture-button construct for treatment of chronic forearm instability.
abstract: BACKGROUND
  The purpose of this study was to report outcomes of interosseous membrane (IOM) reconstruction with a suture-button construct for treatment of chronic longitudinal forearm instability.
  
  
  METHODS
  We performed a retrospective review with prospective follow-up of patients who underwent ulnar shortening osteotomy and IOM reconstruction with the Mini TightRope device from 2011 through 2014. Bivariate statistical analysis was used for comparison of preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, range of motion, grip strength, and ulnar variance. Complications and patient satisfaction were also recorded.
  
  
  RESULTS
  Ten patients (mean age, 45.3 years) satisfied inclusion criteria: 8 treated for post-traumatic sequelae of Essex-Lopresti-type injuries, 1 for forearm instability secondary to previous elbow surgery, and 1 for instability secondary to trauma and multiple elbow surgeries. Surgeries were performed an average of 28.6 months from initial injury. At mean follow-up of 34.6 months after surgery, significant improvement was observed in elbow flexion-extension arc (+23° vs. preoperatively; P = .007), wrist flexion-extension arc (+22°; P = .016), QuickDASH score (-48; P = .000), and ulnar variance (-3.3 mm; P = .006). Three patients required additional surgery: 1 revision ulnar shortening osteotomy for persistent impingement, 1 revision ulnar osteotomy and Mini TightRope removal for lost forearm supination, and 1 fixation of a radial shaft fracture after a fall.
  
  
  CONCLUSIONS
  IOM reconstruction using a suture-button construct is an effective treatment option for chronic forearm instability.
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA. Electronic address: michaelpgaspar@gmail.com.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Gaspar
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kane
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Pflug
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Sidney M
authors.initials: SM
authors.lastname: Jacoby
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: A Lee
authors.initials: AL
authors.lastname: Osterman
authors.affiliation: The Philadelphia Hand Center, P.C., Philadelphia, PA, USA; Department of Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Randall W
authors.initials: RW
authors.lastname: Culp
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008566:Membranes / Q000293:injuries / Q000601:surgery*; D008875:Middle Aged; D009984:Orthopedic Fixation Devices; D010027:Osteotomy; D011446:Prospective Studies; D011885:Radius Fractures / Q000503:physiopathology; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014457:Ulna / Q000601:surgery; D014458:Ulna Fractures / Q000503:physiopathology; D014955:Wrist Joint / Q000503:physiopathology; D055815:Young Adult
keywords: Chronic Essex-Lopresti injury; Mini TightRope suspensionplasty; interosseous membrane reconstruction; longitudinal forearm instability; radioulnar dissociation; suture-button construct