Distal Biceps Rupture | Biceps Tendon Surgery | Vail, Colorado


Uploaded by shoulderspecialists on 30.11.2010

Transcript:
distal biceps tendon rupture
surgical management with single incision approach and cortical button fixation
the incidence if distal biceps rupture
is approximately 1.2 per 100,000
with the mean age being fifty years old
smoking has been shown to increase the risk of rupture by 7.5
times
injury usually is a result of a rapid unexpected eccentric load to the flexed
elbow
patients predominately experience loss of supination strength
whereas flexion strength loss is minimal
the hook test as described by O'Driscoll
is a reliable physical exam finding
MRI imaging has been shown to have a sensitivity of 92 percent and
is useful to differentiate
musculotendinous junction injuries from the more common distal biceps
tendon avulsion
operative options include a single verses two incision technique
complications associated with the two incision technique included higher
incidence of heterotopic ossification
and radioulnar synostosis
multiple fixation options exist when performing a single incision technique
cortical button fixation has been shown to have the highest load to failure
in the following video
we illustrate our preferred single incision technique for repair of distal biceps
tendon rupture with cortical button fixation
the patient is positioned supine with an arm board and a sterile tourniquet
a positive hook test is demonstrated here
the incision is localized using fluoroscopy to identify the biceptical
tuberosity
the extremity is accentuated and tourniquet inflated
a single transverse incision is made
care is taken to identify and protect
the lateral antebrachial cutaneous nerve
if encountered the leash of henry should be ligated
blunt palpation is used to develop the plane between the pronator teres
and brachioradialis muscles
in cases of acute injury
the biceps is easily delivered from its sheath and grasped with an alice clamp
the bulbous end of the tendon is sharply debrided
a tacks suture is then placed
next attention is turned to preparation of the tuberosity
the forearm is placed in extreme supination for optimal exposure
care should be taken so as to not retract vigorously on the radial soft
tissues to prevent injury to the posterior interosseous nerve
a guide pin is then placed perpendicularly through the radial tuberosity
and care should be taken to aim the guide pin away from the
posterior interosseous nerve
ideally the pin is placed on the ulnar aspect of the tuberosity to maximize the
moment arm supination
guide pin placement is confirmed with fluoroscopy
a bone socket is prepared by drilling the anterior cortex with a six or seven
millimeter drill
the cortical fixation button is prepared by placing two sutures through
the button
the button is subsequently placed on an inserter
the button is then passed through the anterior and distal cortices and flipped
the tendon is secured with a type stitch
utilizing one limb
from each suture
the remaining two sutures are the intentions
allowing the botton to act as a pulley introducing the tendon to the socket
each set of sutures are then securely tied
with the elbow in maximal extension and supination
fluoroscopy is once again used to confirm adequate placement of the
button
our routine post operative protocol includes immediate active and active
assisted flexion
no resisted flexion or supination for six weeks
there are multiple advantages to this technique
first of all it is minimally invasive
it provides strong fixation and maximum bone contact for healing
this allows for early rehabilitation
this procedure is also associated with a decreased risk of complications such as
herotopic ossification and radioulnar synostosis