Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloska cesta 9, 1000, Ljubljana, Slovenia.
ESSKA Elbow and Forearm Scientific Committee 2020 - 2022, Milan, Italy.
Int Orthop. 2021 Oct;45(10):2619-2633. doi: 10.1007/s00264-021-05149-4. Epub 2021 Jul 31.
In the last two decades, a strong interest on the interosseous membrane (IOM) has developed.
The authors present a review of the new concepts regarding the understanding of forearm physiology and pathology, with current trends in the surgical management of these rare and debilitating injuries.
Anatomical and biomechanical studies have clarified the anatomy of forearm constrains and their role in forearm longitudinal and transverse stability. The radial pull test, a new intraoperative test, has been developed that might increase the detection on IOM injuries. The forearm is now considered a "functional unit" and, consequently, a new classification has been proposed. Uncommon variants and rare patterns of forearm fracture dislocations have been reported in the literature and could not be classified to those commonly referred to using eponyms (Monteggia, Galeazzi, Essex-Lopresti). The new Artiaco et al. classification includes all injury patterns, thus avoids confusion in the nomenclature, and helps surgeon with detection of lesions and guiding surgical treatment.
Based on the new classification and after current literature review, authors propose a management flowchart for treatment of forearm instability injuries.
在过去的二十年中，人们对骨间膜（IOM）产生了浓厚的兴趣。
作者对理解前臂生理学和病理学的新概念进行了综述，并介绍了目前治疗这些罕见且使人虚弱的损伤的手术管理趋势。
解剖学和生物力学研究阐明了前臂约束的解剖结构及其在维持前臂纵向和横向稳定性方面的作用。现已开发出一种新的术中测试，即桡骨牵拉试验，该试验可能提高对 IOM 损伤的检测能力。现在认为前臂是一个“功能单元”，因此提出了新的分类。文献中报道了罕见的前臂骨折脱位变异和罕见类型，无法按照通常使用的命名法（Monteggia、Galeazzi、Essex-Lopresti）进行分类。新的 Artiaco 等分类法包括所有损伤类型，从而避免了命名上的混淆，并有助于外科医生检测病变并指导手术治疗。
根据新的分类和当前文献回顾，作者提出了一种治疗前臂不稳定损伤的管理流程图。
