ARTICLE IN PRESS

THE LOAD-BEARING CHARACTERISTICS OF THE

FOREARM: PATTERN OF AXIAL AND BENDING FORCE
TRANSMITTED THROUGH ULNA AND RADIUS
H. SHAABAN, G. GIAKAS, M. BOLTON, R. WILLIAMS, P. WICKS, L. R. SCHEKER and V. C. LEES
From the Wythenshawe Hospital, Manchester, UK and the Christine M. Kleinert Institute for Hand and Microsurgery,
Louisville, Kentucky, USA

A biomechanical study was performed on 12 cadaveric arms to dene the normal proles of force
transmission through the ulna and radius and demonstrate the effect on these of simulated injury of
the distal radioulnar joint (DRUJ). Strain gauges were used to measure the axial and bending
forces transmitted through each bone. Axial force transmitted through the ulna is, broadly,
reciprocal to that seen in the radius, with the greatest force seen in supination. In all 12 arms, axial
loading of the hand created an anterior bending force (to create a posterior convexity) in the distal
radius. Axial loading of the hand created an anterior bending force in the distal ulna for half the
specimens and a posterior bending force in the remaining half. Division and division with
reconstruction of either the volar or the dorsal distal radioulnar ligament (DRUL) had no
signicant effect on force transmission through the ulna and radius, while excision of the ulnar head
signicantly disrupted the proles of the axial and bending forces.
Journal of Hand Surgery (British and European Volume, 2006) 31B: 3: 274279
Keywords: wrist biomechanics, radius, ulna, digtal radioulnar joint

The integrity of the osseo-ligamentous structures of the

wrist and forearm is believed to be important for normal
functional load transmission through the forearm
(Birkbeck et al., 1997; Palmer and Werner, 1984;
Shaaban et al., 2004; Trumble et al., 1987). The relative
distribution of loads between the radius and ulna in
different positions of the forearm and the changes
resulting from disruption of the normal anatomy of the
forearm remain unclear and controversial. Early biomechanical studies showed that 40% of the axial load
applied to the hand is transmitted through the ulna
(Palmer and Werner, 1981). Subsequent studies quoted
different gures range between 9% and 37% (af
Ekenstam et al., 1984; Markolf et al., 1998; Trumble
et al., 1987;). Further work by Palmer and Werner
(1984) suggested the true gure to be around 20% and
this last gure has been widely accepted and quoted in
the literature (Palmer and Werner, 1984). Birkbeck et al.
(1997) showed that the neutral position does not,
necessarily, reect the mean force transmitted along
the arc of rotation. It was shown that disruption of the
triangular brocartilage (TFC) (Palmer and Werner,
1984) and of the interosseous membrane (IOM)
(Birkbeck et al., 1997) alter the normal pattern of load
transmission through the forearm.
In a previous publication, we showed that disruption
and reconstruction of the distal radioulnar ligaments
(DRUL) alters the pattern of load transmission across
the distal radioulnar joint (DRUJ) (Shaaban et al.,
2004). In this study, we investigated the normal pattern
of load transmission through the ulna and radius along
the arc of the forearm rotation and its variation with
division and anatomical reconstruction of the DRUL,

or excision of the ulnar head. We also examined the

effect of axial loading on the bending forces created in
both ulna and radius.

MATERIALS AND METHODS

Twelve fresh frozen, intact upper extremities from six
cadavers (two male and four female) were studied. The
mean age was 65 (range 4575) years. The distal forearm
and wrist were dissected, with preservation of the main
stabilizing structures of the wrist and DRUJ (Fig 1). A
jig was designed to hold the arm securely and permit
application of axial loading in various positions of the
forearm, from full supination to full pronation. The arm
was inserted into the jig through a 4.5 mm cortical screw
attached to a universal joint (ball and socket) on the jig
and drilled into the olecranon down the proximal third
of the ulna. A special wrist clamp lined with a pneumatic
cuff was used to hold the hand. The wrist clamp had a
central disc permitting rotation of the forearm. The
central disc was calibrated as a goniometer to measure
degree of rotation. The hand was secured within the
central disc by ination of the pneumatic cuff. The
elbow was held at 901 with the forearm in the horizontal
plane. Lead cubes were used to apply forces through a
pulley system at the rear of the jig.
Two pairs of strain gauges (Graphtec N11-5A8-12011, Japan) were mounted on the volar and dorsal
cortical surfaces of the distal third of ulna and radius,
distal to the insertion of the central band of the IOM.
This location was chosen to avoid the effect of the
central band of the IOM on the force transmitted
274

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275

Fig 1 The experiment construct and strain gauges mounted on the ulna and radius.

through the forearm (Birkbeck et al., 1997). The

periosteum was stripped off and the cortical surfaces
were abraded with ne sandpaper and wiped with
alcohol to produce smooth and dry surfaces. The gauges
were bonded to the bone with cyanoacrylate gel superglue (Fig 1). A special adaptor box was designed to
measure both the axial and bending forces created in the
long bones during loading of the forearm. The adaptor
box was set on a half bridge-series system to measure the
axial force, or a half bridge-parallel system to measure
the bending force.
First, measurements were made on all 12 intact arms.
The measurements were taken with incremental loads
(unloaded condition, 5, 10 kg) along the arc of rotation
of the forearm at maximum pronation (Pmax), 601
pronation (P60), 301 pronation (P30), neutral rotation,
301 supination (S30), 601 supination (S60) and maximum supination (Smax). Subsequently, the arms were
divided into two groups and either the volar, or dorsal,
DRUL was divided and measurements were repeated.
Finally, two surgical procedures used to treat the
damaged DRUJ, were performed. The damaged volar
and dorsal DRULs were reconstructed in six arms (three
arms each) using Schekers technique (Scheker et al.,
1994). Excision of the ulnar head (Darrach, 1913) was
performed on three arms and measurements were
repeated.
In contradistinction to the quantitative values obtained for axial force, it was only possible to obtain
qualitative values for bending force. Quantication of
the bending force depends on various factors including
the density of the bone and the angle of curvature of the
bone. Some of these factors cannot be measured in this
experimental construct. For this reason, only the
direction of bending in the radius and ulna was detected

and readings of the bending force were compared with

each other, with the reading of the unloaded neutral
position as reference point.
Univariate analysis of variance was used. The effect of
loading, rotation and effect of injury and reconstruction
were considered within-subject variables. The difference
between the ligaments (dDRUL and vDRUL) was
considered between-subject variables and type of bone
(ulna and radius) was considered independent of each
other. A P value of o0.05 was judged to denote
signicance.

RESULTS
Axial force transmitted through the ulna and radius
The axial force transmitted through the ulna and radius
was directly related to the applied axial load (Po0.001).
The force increased with loading of the hand and
decreased with unloading. The axial force transmitted
through the ulna signicantly changed throughout the
arc of rotation (Po0.001). It was least at the extreme of
pronation (8% and 14.5% with 5 and 10 kg load,
respectively). It gradually increased as the forearm
moved from pronation to supination. It was maximum
between 301 and 601 supination (46% and 44.5% with 5
and 10 kg load, respectively) (Fig 2a). The remainder of
the axial force passed through the radius. There was a
clearly reciprocal relationship between the axial force
transmitted through the ulna and that transmitted
through the radius. The axial force transmitted through
the radius was least at the extreme of supination. It
increased as the forearm moved from supination to
pronation. It was maximum between 301 and 601

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THE JOURNAL OF HAND SURGERY VOL. 31B No. 3 JUNE

4
0kg
5kg
10kg

3
2
1
0
P60

P30 Neutral S30

Position of forearm

S60

Smax

Pmax

9
8
7
6
5
4
3
2
1
0

P60

P30 Neutral S30

Position of forearm

S60

Smax

Fig 2 (a) Axial force through the ulna with an intact DRUJ. (b) Axial
force through the radius with an intact DRUJ.

pronation. However, the difference along the arc of

rotation was insignicant (P 0:99) (Fig 2b).
With a 5 kg load, the mean axial forces passing
through the ulna and radius in different positions were
32% and 68%, respectively. With 10 kg loads, it was
34% and 66% passing through the ulna and radius,
respectively.

Bending force created in the ulna and radius

In all 12 arms, axial loading of the hand created an
anterior bending force in the distal radius to create a
posterior convexity. Axial loading of the hand created
an anterior bending force in the distal ulna in half of the
forearms and a posterior bending force in the remaining
half. The bending force created in the radius and ulna
increased with loading the hand and decreased with
unloading and was directly related to the applied axial
load (Po0.001).
The bending force created in the radius and ulna
varied signicantly along the arc of rotation (Po0.001).
It was least at the extreme of pronation. It gradually
increased as the forearm moved from pronation to
supination. It was maximum at the extreme of supination. In contrast to the axial forces, where ulna and
radius showed broadly reciprocal changes, the pattern of
bending force was similar in both ulna and radius.

P30 Neutral S30

Position of forearm

S60

P30 Neutral S30

Position of forearm

S60

Smax

0kg
5kg
10kg

Pmax

P60

(a) -1

Relative force

Force (kg)

0
Pmax

(a) -2

(b)

0kg
5kg
10kg

3
Relative force

Force (kg)

-1

2006

2
1
0
Pmax

(b) -1

P60

Smax

Fig 3 (a) Pattern of bending force created in the ulna with an intact
DRUJ. (b) Pattern of bending force created in the radius with
an intact DRUJ.

However, the relative change was greater in the ulna as

the forearm moved into supination (Fig 3).

Effect of division of either the volar or dorsal DRUL

Division of a single DRUL had no signicant effect on
the pattern of axial force transmission through both the
ulna (P 0:82) and the radius (P 0:83). This included
the effect of loading and the effect of position of the
forearm. There was also no signicant difference on
axial force transmission through both the ulna
(P 0:66) and radius (P 0:21) between dividing the
volar, or dorsal, ligament.
The relative distribution of axial force transmitted
through the ulna and radius was similar to that of the
intact arms. With a 5 kg load, the mean axial forces
passing through the ulna and the radius in different
positions were 34% and 66%, respectively. With 10 kg
loads, 36% and 64% passed through the ulna and
radius, respectively.
Division of a single DRUL had no signicant effect
on the pattern or direction of bending force created in
both the ulna (P 0:37) and the radius (P 0:77). This
included the effect of loading and the effect of position
of the forearm. There was no signicant difference

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277

between dividing the dorsal or volar DRUL in both the

ulna (P 0:46) and radius (P 0:83).

Reconstruction of the divided DRUL had no signicant

effect on the pattern of axial force transmission through
the ulna (P 0:52) and radius (P 0:78). There was no
signicant difference between the effect of reconstructing the volar, or the dorsal, ligament on axial force
transmission through both the ulna (P 0:12) and
radius (P 0:25). There was a slight increase in the
mean axial force transmitted through the ulna as a result
of reconstruction of the divided DRUL. However, the
difference was insignicant (P 0:52). The data showed
that, with 5 kg loads, the mean axial forces passing
through the ulna and radius were 40% and 60%,
respectively. With 10 kg loads, 39% and 61% passed
through the ulna and radius, respectively.
Reconstruction of a single DRUL had no signicant
effect on the pattern or direction of bending force
created in both the ulna (P 0:77) and radius
(P 0:95). This included the effect of loading and the
effect of position of the forearm. There was no
signicant difference between reconstructing the dorsal,
or volar, DRUL in both the ulna (P 0:45) and radius
(P 0:14).

0kg
5kg
10kg

0
Pmax

P60

Excision of the ulna head resulted in signicant changes

in the pattern of the axial and bending force transmitted
through the ulna and radius. The axial force transmitted
through the ulna showed signicant reduction compared
to that in the intact arms (P 0:02) with no signicant
difference between different loads (Po0.15) and between different positions of the forearm (P 0:40). The
axial force transmitted through the radius showed no
signicant change compared to that of the intact arms
(P 0:89) with signicant difference between different
loads (Po0.001). However, there was no signicant
difference between different positions of the forearm
(P 0:98), i.e. the axial force transmitted through the
radius hardly varied (Fig 4). The data showed that, with
a 5 kg load, the mean axial force passing through the
ulna and radius were 2.5% and 97.5%, respectively.
With 10 kg loads, 2% and 98% passed through the ulna
and radius, respectively.
The data showed that excision of the ulnar head
signicantly reduced the bending force created in the
ulna (P 0:03). By contrast, it had no signicant effect
on the pattern, or direction, of bending force created in
the radius. This included the effect of loading (P 0:80)
and the effect of position (P 0:13).

Neutral

S30

S60

Smax

0
Pmax
(b)

Effect of excision of the ulna head

P30

Position of forearm

(a) -2

Force (kg)

Effect of ligament reconstruction

Force (kg)

P60

P30 Neutral S30

Position of forearm

S60

Smax

Fig 4 (a) Axial force through the ulna after Darrachs procedure. (b)
Axial force through the radius after Darrachs procedure.

DISCUSSION
The principal ndings of this study are as follows:
1. Two-thirds of the mean axial load was transmitted through the radius, while one-third was
transmitted through the ulna in the normal forearm.
There was a reciprocal relationship between the
axial force transmitted along the radius and that
along the ulna.
2. Axial loading of the hand resulted in an anterior
bending force (to create a posterior convexity) in the
distal radius of all specimens. By contrast, it resulted
in an anterior bending force in the distal ulna of half
of the specimens and a posterior bending force in the
other half.
3. Division, or reconstruction after division, of either
the volar, or the dorsal, DRUL had no signicant
effect on force transmission through the ulna and
radius, while excision of the ulnar head signicantly
altered the patterns of force transmission through the

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THE JOURNAL OF HAND SURGERY VOL. 31B No. 3 JUNE

The force transmitted through the radius and ulna

depends on the primary force transmitted to each bone
across the radiocarpal joint and how this primary force
is modied as it passes through the DRUJ (Shaaban et
al., 2004), IOM (Birkbeck et al., 1997) and proximal
radioulnar joint (PRUJ) (Bartz et al., 1984).
Palmer and Werner (1981), showed that 40% of the
axial load was transmitted through the ulna in their
original study. In a subsequent study, which is widely
quoted in the literature (Palmer and Werner, 1984) they
showed only 20% of the axial load was transmitted
through the ulna. Both studies were limited in so far as
they measured the force in only one position, namely
neutral forearm rotation. They considered the force
transmitted in that position as the mean force transmitted along the arc of rotation. Our study and a
previous one (Birkbeck et al., 1997) have shown that the
neutral position does not necessarily reect the mean
force transmitted along the arc of rotation, as both
studies showed more axial force was transmitted
through the ulna in supination than pronation. Also,
this study showed that the mean axial load transmitted
through the ulna was between 32 and 34%, with the
balance being transmitted through the radius. These
gures are closer to those shown by Birkbeck et al.
(1997) and signicantly more than those shown by
Palmer and Werner (1984).
This study showed a broadly, reciprocal arrangement
of force transmission through the radius and ulna, such
that axial force increased in the ulna as it decreased in
the radius, and vice-versa. This arrangement reects the
complex osseo-ligamentous system of the forearm and
its role in the smooth distribution of force. This also
supports the theory that the DRUJ, IOM and PRUJ
work as a unique, single unit to distribute force between
the ulna and radius. The roles of the IOM and the PRUJ
have been investigated by Birkbeck et al. (1997) and
Bartz et al. (1984), respectively, while the role of the
DRUJ was investigated by Shaaban et al. (2004).
According to current understanding, the ulna should
be relatively longer (proximal to distal displacement) in
pronation and consequently more force should pass
through the ulna (Epner et al., 1982). Interestingly, this
study showed less force transmitted through the ulna in
pronation. This could be explained by the volardorsal
shift in the position of the ulnar head relative to the
carpus. In pronation, the ulnar head moves dorsal
relative to the carpus. This results in less force
transmitted from the carpus to the ulna. Conversely,
load transmission through the ulna peaks at 601
supination and this position corresponds to the ulna
head lying in direct alignment with the carpus (Adams
and Berger, 2002).
Although it was shown that division of a single
DRUL, with or without reconstruction, changes the

pattern of force distribution across the DRUJ (Shaaban

et al., 2004), this study has shown that these surgical
activities have no signicant effect on axial force
distribution between the ulna and radius. However,
excision of the ulna head (Darrachs procedure) almost
eliminated force transmission through the ulna and
almost all of the axial force passing through the forearm
was transmitted through the radius. Interestingly, the
total axial force transmitted through the radius and ulna
after Darrachs procedure was less than that with an
intact DRUJ i.e. there seems to have been some
dissipation of force (Fig 5). One possible explanation
is that the radius loses the support of the ulna head after
Darrachs procedure and impinges on the ulna stump
resulting in disruption of the co-linear alignment of axes
of force between the hand and forearm, i.e. there is a Vshaped collapse of the links in the chain (Fig 6). In the
clinical situation, functioning muscle groups could
attempt to counter this collapse and absorb this portion
of the force. Loss of the co-linear alignment and the
load-bearing function of the DRUJ (Shaaban et al.,
2004) are offered as explanations for the loss of grip
strength normally seen after Darrachs procedure (Lees
and Scheker, 1996).
This study is the rst to investigate the bending force
created in the ulna and radius as a result of axial loading
of the hand. Although the absolute bending force could
not be measured, the study showed that axial loading of
the hand resulted in an anterior bending force in the
radius of all specimens while it resulted in an anterior
bending force in the ulna of half of the specimens and a
posterior bending force in the other half. This result
correlates with the anatomical observation that the
distal shaft of radius has a posteriorly convex curvature
while the direction of curvature of the distal third of the
shaft of ulna varies anatomically. We believe that the
direction of bending depends mainly on the natural

8
7
Ulna
Radius

6
Force (kg)

forearm and resulted in the mechanical equivalent of

a one-bone forearm.

2006

5
4
3
2
1
0
Normal

Injured

Reconst

Darrach

Fig 5 Distribution of axial force between the ulna and radius with a
10 kg load in different conditions.

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279

Darrachs procedure is secondary to reduction of the

axial force transmitted through the ulna.
This biomechanical study supports the clinical observation that excision of the ulnar head results in much
more reduction in load-bearing capacity of the affected
arm than that with a single DRUL injury.
Acknowledgements
The authors would like to thank Wythenshawe Hospital Plastic
Surgery Endowment Fund, the Sanof foundation and the Jewish
Hospital, Louisville, Kentucky for their nancial support of the study.

References

Fig 6 Disruption of the normal alignment between the radius and

carpal bones after Darrachs procedure (a) normal alignment
(b) alignment after Darrachs procedure.

curvatures of the bone. Axial loading overstresses these

natural curvatures.
This study also showed that the amplitude of the
bending force is directly related to the axial loading of
the hand. As axial loading increases, the bending force
in both ulna and radius increases. Bone is classied,
physically, as a brittle material with a very small plastic
range and relatively low tensile strength (Cordey and
Gautier, 1999). This means that, at certain axial load,
the bending force created in the bone would reach the
level of failure and fracture occurs. The results suggest
that the direction and amplitude of bending force are
important factors in determining the site and displacement of any fracture of the bone. However, there are
other factors, such as the strength and direction of
pulling of the overlying muscles and the quality of the
bone, which play an important role in the pathomechanics of fractures. These could not be investigated in this
study. These complex anatomical and biomechanical
variations may explain why apparently similar patterns
of force might produce the Monteggia and Galeazzi
fracture patterns.
The study showed that division, with or without
reconstruction, of a single DRUL has no signicant
effect on the pattern of bending force created in both
ulna and radius. However, excision of the ulnar head
abolished the bending force in the ulna. We believe that
reduction in the bending force in the ulna with

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Received: 8 November 2004
Accepted after revision: 9 December 2005
Miss V.C. Lees, Department of Plastic Surgery, Acute Block, Wythenshawe Hospital,
Southmoor Road, Wythenshawe, Manchester M23 9LT, UK. Tel.: +44 161 291 6648; fax:
+44 161 291 6381.
E-mail: vlees@dsl.pipex.com

r 2006 The British Society for Surgery of the Hand. Published by Elsevier Ltd. All rights
reserved.
doi:10.1016/j.jhsb.2005.12.009 available online at http://www.sciencedirect.com