Skip to main content
SpringerLink
Log in

Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The proximal radioulnar joint (PRUJ) and the radiocapitellar joint may be destabilized after trauma. Different techniques for stabilization of PRUJ have been proposed, but none of them can stabilize the radiocapitellar joint at the same time. We propose a ligamentoplasty to stabilize the radial head at these two joints by reconstructing the radial head annular ligament and the lateral collateral ulnar ligament (LCUL) with a single graft (palmaris longus or gracilis tendon of the knee).

Methods

Fifteen cadaveric upper limbs were used to compare the stabilization obtained by performing our ligamentoplasty with the palmaris longus or the gracilis tendon. For each technique, the stabilization obtained was evaluated by measuring the displacement of the radial head in the anterior, lateral and posterior directions when a force of 1 N was applied in maximum supination, neutral rotation and maximum pronation. We also evaluated whether this technique could damage the ulnar nerve or the posterior interosseous nerve by dissecting them and whether it could limit the range of rotation of the forearm.

Results

Our ligamentoplasty enables to restore PRUJ stability equivalent to the intact ligament condition. The palmaris longus was inconstant (13/15) and too short to allow concomitant reconstruction of the LCUL (except in one case). No nerve damage was found during the dissection, and the range of rotation of the forearm was not limited by the ligamentoplasty. We also report a clinical case with an excellent result and without complications.

Conclusion

This ligamentoplasty we have described makes it possible to stabilize the radial head with respect to the radial notch of the ulna and with respect to the capitellum of the humerus. The gracilis tendon is more suitable than the palmaris longus because of its constant presence and length. A clinical series is now necessary to better evaluate this technique.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Availability of data and material

Experimental data are available.

References

  1. Green JB, Zelouf DS (2009) Forearm instability. J Hand Surg Am 34(5):953–961. https://doi.org/10.1016/j.jhsa.2009.03.018

    Article  PubMed  Google Scholar 

  2. McGlinn EP, Sebastin SJ, Chung KC (2013) A historical perspective on the essex-lopresti injury. J Hand Surg Am 38(8):1599–1606. https://doi.org/10.1016/j.jhsa.2013.04.031

    Article  PubMed  PubMed Central  Google Scholar 

  3. Camp CL, Fu M, Jahandar H, Desai VS, Sinatro AM, Altchek DW, Dines JS (2019) The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments. J Shoulder Elb Surg 28(4):665–670. https://doi.org/10.1016/j.jse.2018.09.019

    Article  Google Scholar 

  4. Otayek S, Tayeb AE, Assabah B, Viard B, Dayan R, Lazure T, Soubeyrand M (2016) Squared ligament of the elbow: anatomy and contribution to forearm stability. Surg Radiol Anat 38(2):237–244. https://doi.org/10.1007/s00276-015-1539-z

    Article  PubMed  Google Scholar 

  5. Otayek S, Tayeb AA, Assabah B, Viard B, Dayan R, Lazure T, Soubeyrand M (2015) Squared ligament of the elbow: anatomy and contribution to forearm stability. Surg Radiol Anat. https://doi.org/10.1007/s00276-015-1539-z

    Article  PubMed  Google Scholar 

  6. Hayami N, Omokawa S, Iida A, Kraisarin J, Moritomo H, Mahakkanukrauh P, Shimizu T, Kawamura K, Tanaka Y (2017) Biomechanical study of isolated radial head dislocation. BMC Musculoskelet Disord 18(1):470. https://doi.org/10.1186/s12891-017-1829-1

    Article  PubMed  PubMed Central  Google Scholar 

  7. Soubeyrand M, Lafont C, De Georges R, Dumontier C (2007) Traumatic pathology of antibrachial interosseous membrane of forearm. Chir Main 26(6):255–277. https://doi.org/10.1016/j.main.2007.09.004

    Article  PubMed  Google Scholar 

  8. Loeffler BJ, Green JB, Zelouf DS (2014) Forearm instability. J Hand Surg Am 39(1):156–167. https://doi.org/10.1016/j.jhsa.2013.07.010

    Article  PubMed  Google Scholar 

  9. Leung YF, Ip SP, Ip WY, Kam WL, Wai YL (2005) The crisscross injury mechanism in forearm injuries. Arch Orthop Trauma Surg 125(5):298–303. https://doi.org/10.1007/s00402-005-0805-7

    Article  CAS  PubMed  Google Scholar 

  10. Bryan RS (1971) Monteggia fracture of the forearm. J Trauma 11(12):992–998

    Article  CAS  Google Scholar 

  11. Cheung EV, Yao J (2009) Monteggia fracture-dislocation associated with proximal and distal radioulnar joint instability. a case report. J Bone Jt Surg Am 91(4):950–954. https://doi.org/10.2106/JBJS.H.00269

    Article  Google Scholar 

  12. Deshpande S, O’Doherty D (2001) Type I monteggia fracture dislocation associated with ipsilateral distal radial epiphyseal injury. J Orthop Trauma 15(5):373–375

    Article  CAS  Google Scholar 

  13. Rehim SA, Maynard MA, Sebastin SJ, Chung KC (2014) Monteggia fracture dislocations: a historical review. J Hand Surg Am 39(7):1384–1394. https://doi.org/10.1016/j.jhsa.2014.02.024

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bell Tawse AJ (1965) The treatment of malunited anterior monteggia fractures in children. J Bone Jt Surg Br 47(4):718–723

    Article  CAS  Google Scholar 

  15. Cappellino A, Wolfe SW, Marsh JS (1998) Use of a modified Bell Tawse procedure for chronic acquired dislocation of the radial head. J Pediatr Orthop 18(3):410–414

    CAS  PubMed  Google Scholar 

  16. Oner FC, Diepstraten AF (1993) Treatment of chronic post-traumatic dislocation of the radial head in children. J Bone Jt Surg Br 75(4):577–581

    Article  CAS  Google Scholar 

  17. Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, Kato H (2009) Long-term clinical and radiographic outcomes after open reduction for missed monteggia fracture-dislocations in children. J Bone Jt Surg Am 91(6):1394–1404. https://doi.org/10.2106/JBJS.H.00644

    Article  Google Scholar 

  18. Wang MN, Chang WN (2006) Chronic posttraumatic anterior dislocation of the radial head in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision. J Orthop Trauma 20(1):1–5

    Article  Google Scholar 

  19. Ghinea CA, Gavriliu S, Georgescu I, Vlad C, Japie E, Parvan A, Ghita R (2013) Burnei’s technique in the treatment of radial head displacement; innovative surgery. study on two cases. J Med Life 6(1):26–33

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Raouf HA, Kader GA, Jaradat A, Dharap A, Fadel R, Salem AH (2013) Frequency of palmaris longus absence and its association with other anatomical variations in the Egyptian population. Clin Anat 26(5):572–577. https://doi.org/10.1002/ca.22186

    Article  PubMed  Google Scholar 

  21. Yong MW, Yusof N, Rampal L, Arumugam M (2017) Prevalence of absence of palmaris longus and its association with gender, hand dominance and absence of FDS tendon to little finger among Malay population. J Hand Surg Asian Pac 22(4):484–489. https://doi.org/10.1142/S021881041750054X

    Article  Google Scholar 

  22. Cinque ME, Schickendantz M, Frangiamore S (2020) Review of anatomy of the medial ulnar collateral ligament complex of the elbow. Curr Rev Musculoskelet Med 13(1):96–102. https://doi.org/10.1007/s12178-020-09609-z

    Article  PubMed  PubMed Central  Google Scholar 

  23. Soubeyrand M, Ciais G, Wassermann V, Kalouche I, Biau D, Dumontier C, Gagey O (2011) The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane. J Bone Jt Surg Br 93(10):1389–1394. https://doi.org/10.1302/0301-620X.93B10.26590

    Article  CAS  Google Scholar 

  24. Soubeyrand M, Wassermann V, Hirsch C, Oberlin C, Gagey O, Dumontier C (2011) The middle radioulnar joint and triarticular forearm complex. J Hand Surg Eur 36(6):447–454. https://doi.org/10.1177/1753193410396976

    Article  CAS  Google Scholar 

  25. Adams JE (2017) Forearm instability: anatomy, biomechanics, and treatment options. J Hand Surg Am 42(1):47–52. https://doi.org/10.1016/j.jhsa.2016.10.017

    Article  PubMed  Google Scholar 

  26. Galik K, Baratz ME, Butler AL, Dougherty J, Cohen MS, Miller MC (2007) The effect of the annular ligament on kinematics of the radial head. J Hand Surg [Am] 32(8):1218–1224. https://doi.org/10.1016/j.jhsa.2007.06.008

    Article  Google Scholar 

  27. Biewener A, Bischoff F, Rischke T, Tille E, Nimtschke U, Kasten P, Schaser KD, Nowotny J (2019) Instability of the proximal radioulnar joint in monteggia fractures-an experimental study. J Orthop Surg Res 14(1):392. https://doi.org/10.1186/s13018-019-1367-7

    Article  PubMed  PubMed Central  Google Scholar 

  28. David-West KS, Wilson NI, Sherlock DA, Bennet GC (2005) Missed monteggia injuries. Injury 36(10):1206–1209. https://doi.org/10.1016/j.injury.2004.12.033

    Article  PubMed  Google Scholar 

  29. Tosun B, Selek O, Buluc L, Memisoglu K (2008) Chronic post-traumatic radial head dislocation associated with dissociation of distal radio-ulnar joint: a case report. Arch Orthop Trauma Surg 128(7):669–671. https://doi.org/10.1007/s00402-007-0456-y

    Article  PubMed  Google Scholar 

  30. Agarwal A, Pawar I (2017) Neglected type I monteggia fracture dislocation in adult. J Clin Diagn Res 11(8):RD01–RD02. https://doi.org/10.7860/JCDR/2017/28250.10468

    Article  PubMed  PubMed Central  Google Scholar 

  31. Chen HY, Wu KW, Dong ZR, Huang SC, Kuo KN, Wang TM (2018) The treatment of chronic radial head dislocation in monteggia fracture without annular ligament reconstruction. Int Orthop 42(9):2165–2172. https://doi.org/10.1007/s00264-018-3943-6

    Article  PubMed  Google Scholar 

  32. Hirayama T, Takemitsu Y, Yagihara K, Mikita A (1987) Operation for chronic dislocation of the radial head in children. reduction by osteotomy of the ulna. J Bone Jt Surg Br 69(4):639–642

    Article  CAS  Google Scholar 

  33. Datta T, Chatterjee N, Pal AK, Das SK (2014) Evaluation of outcome of corrective ulnar osteotomy with bone grafting and annular ligament reconstruction in neglected monteggia fracture dislocation in children. J Clin Diagn Res 8(6):LC01-04. https://doi.org/10.7860/JCDR/2014/9891.4409

    Article  PubMed  PubMed Central  Google Scholar 

  34. Liao S, Pan J, Lin H, Xu Y, Lu R, Wu J, Zhao M, Chen H, Cai M, Ding X, Zhao J (2019) A new approach for surgical treatment of chronic monteggia fracture in children. Injury 50(6):1237–1241. https://doi.org/10.1016/j.injury.2019.04.017

    Article  PubMed  Google Scholar 

  35. Boyd HB, Boals JC (1969) The monteggia lesion. a review of 159 cases. Clin Orthop Relat Res 66:94–100

    Article  CAS  Google Scholar 

  36. Bhaskar A (2009) Missed monteggia fracture in children: is annular ligament reconstruction always required? Indian J Orthop 43(4):389–395. https://doi.org/10.4103/0019-5413.55978

    Article  PubMed  PubMed Central  Google Scholar 

  37. Lloyd-Roberts GC, Bucknill TM (1977) Anterior dislocation of the radial head in children: aetiology, natural history and management. J Bone Jt Surg Br 59-B(4):402–407

    Article  CAS  Google Scholar 

  38. Pari C, Puzzo A, Paderni S, Belluati A (2018) Annular ligament repair using allograft for the treatment of chronic radial head dislocation: a case report. Acta Biomed 90(1):154–157

    PubMed  Google Scholar 

  39. Yammine K, Eric M (2020) Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. a systematic review of cadaveric studies. Surg Radiol Anat 42(3):259–267. https://doi.org/10.1007/s00276-019-02381-x

    Article  PubMed  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Public Assistance Hospital of Paris, Ecole de Chirurgie, 7 rue du Fer à Moulin, 75221, Paris, France

    Cyril Guetari

  2. Department of Radiology, Public Assistance Hospital of Paris, Universitary Hospital of Bicêtre, 78 rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Maud Creze

  3. Department of Orthopaedic Surgery, Clinique Saint Jean L’Ermitage, 272 Av MArc Jacquet, 77000, Melun, France

    Marc Soubeyrand

Authors
  1. Cyril Guetari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maud Creze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Soubeyrand
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made contributions to the conception and design of the study, acquisition of data, analysis and interpretation of data and drafting the article or revising it, and gave final approval of the submitted version.

Corresponding author

Correspondence to Marc Soubeyrand.

Ethics declarations

Conflict of interest

None of the authors have a conflict of interest to declare.

Ethical approval

This study was conducted at the Paris School of Surgery. The ethical rules of our institution were respected.

Consent to participate

In this article, we report the clinical case of a patient who has given his written consent for the use of his anonymized data for the purposes of this publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guetari, C., Creze, M. & Soubeyrand, M. Stabilization of the radial head with the palmaris longus or the gracilis tendon: an anatomical feasibility study. Eur J Orthop Surg Traumatol 31, 651–659 (2021). https://doi.org/10.1007/s00590-020-02815-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-020-02815-y

Keywords

Search

Navigation