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The Journal of Bone and Joint Surgery (American) 84:1970-1976 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Articles

Radius Pull Test: Predictor of Longitudinal Forearm Instability

Adam M. Smith, MD, Leah R. Urbanosky, MD, Jason A. Castle, MD, Julia T. Rushing, MStat and David S. Ruch, MD

Investigation performed at Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina

Adam M. Smith, MD
Leah R. Urbanosky, MD
Jason A. Castle, MD
Julia T. Rushing, MStat
David S. Ruch, MD
Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Box 1070, Winston-Salem, NC 27157. E-mail address for D.S. Ruch: druch{at}wfubmc.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Longitudinal instability of the forearm (the Essex-Lopresti lesion) following radial head excision may be difficult to detect. This cadaveric study examines a stress test that can be performed in the operating room to identify injury to the ligamentous structures of the forearm.

Methods: Twelve cadaveric upper extremities were randomized into two groups and underwent radial head resection. Group 1 underwent sequential transection of the triangular fibrocartilage complex and the interosseous membrane. Group 2 underwent sequential transection of the interosseous membrane and the triangular fibrocartilage complex. Ulnar variance and radial migration were examined with use of fluoroscopy of the wrist before, during, and after the application of a 9.1-kg load via longitudinal traction on the proximal part of the radius.

Results: Group 1 demonstrated no significant changes in proximal radial migration with load (compared with the findings after radial head resection alone) after transection of the triangular fibrocartilage complex. However, Group 2 demonstrated significant changes in proximal radial migration with load after transection of the interosseous membrane (p = 0.03; median, 3.5 mm). In both groups, transection of both the triangular fibrocartilage complex and the interosseous membrane resulted in significant changes in proximal radial migration with load (p = 0.001; median, 9.5 mm). When the load was removed, specimens were ulnar positive (median, 3.0 mm), with no specimen returning to the preload position of ulnar variance (p = 0.001).

Conclusion: After radial head resection, 3 mm of proximal radial migration with longitudinal traction indicated disruption of the interosseous membrane. In all specimens, proximal radial migration of >=6 mm with load indicated gross longitudinal instability with disruption of all ligamentous structures of the forearm.

Clinical Relevance: Early detection of longitudinal instability of the forearm is essential for successful management. If radial head resection is necessary, longitudinal traction on the proximal part of the radius may provide useful information regarding the ligamentous support of the forearm and assist in deciding whether to simply excise or to repair or replace the radial head.


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