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Radius pull test: predictor of longitudinal forearm instability.

Adam M Smith1, Leah R Urbanosky, Jason A Castle

  • 1Department of Orthopedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Box 1070, Winston-Salem, NC 27157, USA.

The Journal of Bone and Joint Surgery. American Volume
|November 14, 2002
PubMed
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A new stress test can detect forearm instability after radial head excision. Over 3mm of radial migration indicates interosseous membrane disruption, while 6mm suggests complete ligamentous injury.

Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Anatomy

Background:

  • Forearm longitudinal instability, known as the Essex-Lopresti lesion, can be challenging to diagnose after radial head excision.
  • A reliable intraoperative stress test is needed to identify injuries to forearm ligamentous structures.

Purpose of the Study:

  • To evaluate a novel stress test for detecting forearm longitudinal instability following radial head resection in a cadaveric model.
  • To correlate specific degrees of proximal radial migration with the integrity of the triangular fibrocartilage complex and interosseous membrane.

Main Methods:

  • Twelve cadaveric upper extremities underwent radial head resection.
  • Sequential transection of the triangular fibrocartilage complex and interosseous membrane was performed in two groups.

Related Experiment Videos

  • Longitudinal traction (9.1-kg load) was applied to the proximal radius, with radial migration and ulnar variance assessed via fluoroscopy.

    • Main Results:

    • Transection of the interosseous membrane significantly increased radial migration under load (p = 0.03).
    • Complete disruption of both the triangular fibrocartilage complex and interosseous membrane resulted in substantial radial migration (median, 9.5 mm; p = 0.001).
    • Specimens exhibited persistent ulnar positive variance after load removal, indicating residual instability.

    Conclusions:

    • Proximal radial migration exceeding 3 mm with longitudinal traction after radial head resection suggests interosseous membrane disruption.
    • A migration of 6 mm or more indicates gross longitudinal instability with complete disruption of forearm ligamentous structures.
    • This stress test can aid in identifying forearm instability during surgery.