Joseph McGinley MS, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Interosseous membrane (IOM) disruption typically occurs following traumatic forearm injury. Unrecognized IOM injury ultimately results in longitudinal forearm instability with chronic pain and reduced range of motion. There currently is no definitive criteria for diagnosing IOM lesions. The purpose of this study was to define criteria for IOM injury diagnosis using MRI and examine their effectiveness in identifying IOM disruption in a double-blinded in-vitro study of forearm trauma. Methods and Materials: Sixteen cadaver arms were subjected to longitudinal trauma in an in-vitro forearm injury model. Each specimen was tested in elbow extension and three rotational positions (supination n = 6, neutral n = 6, pronation n = 4). A 27 kg axial load was applied from a height of 90 cm onto the distal radius. Prior to and following the creation of each lesion, longitudinal and axial MRI images were obtained. Subsequently, the specimens were dissected by a blinded investigator, describing the extent, location, and type of IOM injury. The MRI images were examined by a blinded radiologist. The procedure and criteria used for examination of IOM competence include the following: 1) identify the extent of the oblique cord from the ulna directed proximally to the radius, 2) examine the forearm beginning just distal to the proximal radio-ulnar joint identifying the IOM origin along the radius, 3) identify the IOM mid-substance traversing the interosseous space in the central third of the forearm, 4) examine the distal third of the forearm, identifying the IOM insertion along the distal ulna, 5) measure the interosseous space between the radius and ulna at a point proximal and distal in the forearm and at its largest central dimension. Results: Dissection revealed IOM injury in eight specimens. Seven demonstrated complete IOM disruption from its ulnar insertion and one revealed a mid-substance tear. Four specimens also had a concomitant tear of the oblique cord of the IOM. Using the above criteria, MRI analysis identified the IOM injury in seven forearms. The correct injury location was identified in six. When injured, the oblique cord of the IOM was not identifiable using MRI. Conclusion: Overall, MRI demonstrated a positive predictive value of 100%, and a negative predictive value of 89% with a 87.5% sensitivity and 100% specificity. This study was the first to outline criteria for examining IOM competence using MRI. Clinically, MRI of the forearm should be obtained in any instance of axial trauma to determine the IOM status prior to definitive treatment.       Questions about this event email: mcginleyjoseph@hotmail.com

McGinley MS, J, MRI Diagnostic Criteria for Interosseous Membrane Injury Following Forearm Trauma.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3102179.html