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Ott N, Hackl M, Van Parys M, Leschinger T, Wegmann K, Müller LP. Distal Triceps Rupture with an Injury of the Medial Ulnar Collateral Ligament: a Result of a Fall Onto an Outstretched Arm - a Case Series. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:79-84. [PMID: 35926766 DOI: 10.1055/a-1865-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Traumatic triceps tendon ruptures are rare and known to result in substantial disability unless appropriate surgical treatment is performed. A traumatic rupture can occur due to a fall onto the outstretched hand. Tearing of the triceps tendon results in a valgus load onto the elbow, which can lead to injuries to the radial head/neck and/or the ulnar collateral ligament. Hence, attention must be paid to associated pathologies after diagnosis of rupture to the distal triceps tendon. Our surgical procedure in these cases includes diagnostic arthroscopy to detect concomitant injuries. In the following, we present three cases where we performed an open suture bridge repair of the triceps tendon followed by suture repair of the ulnar collateral ligament. All patients recovered well and reported no elbow pain or limited range of motion. The ASES and Mayo Elbow Performance scores were 100 at the 1-year follow-up.
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Affiliation(s)
- Nadine Ott
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Michael Hackl
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | | | - Tim Leschinger
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Kilian Wegmann
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
- -, Orthopädische Chirurgie München (OCM), München, Germany
| | - Lars Peter Müller
- Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany
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Najefi AA, Domos P. A unique case of bilateral triceps avulsion fracture in a patient with pseudohypoparathyroidism. Shoulder Elbow 2021; 13:334-338. [PMID: 34659475 PMCID: PMC8512989 DOI: 10.1177/1758573219876553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results. We describe the pathophysiology of this injury and the unique method of fixation, which can be an alternative effective method to repair these injuries.
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Affiliation(s)
- Ali-Asgar Najefi
- Ali-Asgar Najefi, Trauma & Orthopaedic
Department, Royal Free Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet EN5
3DJ, UK.
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Lee JH, Ahn KB, Kwon KR, Kim KC, Rhyou IH. Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop Relat Res 2021; 479:781-789. [PMID: 33181575 PMCID: PMC8083823 DOI: 10.1097/corr.0000000000001550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 10/07/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic distal triceps tendon rupture results in substantial disability in the absence of an appropriate diagnosis and treatment. To the best of our knowledge, differences in the degree of injury according to the injury mechanisms and associated lesions are not well known. QUESTIONS/PURPOSES In this study, we asked: (1) What differences are seen in triceps tear patterns between indirect injuries (fall on an outstretched hand) and direct injuries? (2) What are the associated elbow and soft tissue injuries seen in indirect and direct triceps ruptures? METHODS Between 2006 and 2017, one center treated 73 elbows of 72 patients for distal triceps tendon rupture. Of those, 70% (51 of 73 elbows) was excluded from this study; 8% (6 of 73) were related to systemic diseases, 59% (43 of 73) sustained open injuries, and 3% (2 of 73) were related to local steroid injections. We retrospectively collected data on traumatic distal triceps tendon rupture in 30% (22 of 73) of elbows at a single trauma center during a 10-year period. A fall on an outstretched hand was the cause of injury in 15 patients and direct blow by object or contusion were the cause in seven. MRI and surgery were performed in all patients. Traumatic distal triceps tendon rupture was classified by the Giannicola method, which is classified according to the depth and degree of the lesion based on MRI and surgical findings. Associated fractures and bone contusions on MRI were characterized. Ligament injuries on MRI was divided into partial and complete rupture. Agreement between the MRI and intraoperative findings for the presence of a traumatic distal triceps tendon rupture was perfect, and the Giannicola classification of traumatic distal triceps tendon rupture was good (kappa = 0.713). RESULTS In the indirect injury group (fall on an outstretched hand), 15 of 15 patients had injuries that involved only the tendinous portion of the distal triceps, but these injuries were not full-thickness tears, whereas in the direct injury group, three of seven patients had a full-thickness rupture (odds ratio [OR] 1.75 [95% CI 0.92 to 3.32]; p = 0.02). The direct injury group had no associated ligamentous injuries while 14 of 15 patients with indirect injuries had ligamentous injuries (OR 0.13 [95% CI 0.02 to 0.78]; p < 0.001; associated injuries in the indirect group: anterior medial collateral ligament [14 of 15], posterior medial collateral ligament [7 of 15], and lateral collateral ligament complex [2 of 15]). Similarly, one of seven patients in the direct injury group had a bone injury (capitellar contusion), whereas 15 of 15 patients with indirect ruptures had associated fractures or bone contusions (OR 16.0 [95% CI 2.4 to 106.7]; p < 0.001). CONCLUSION A fall on an outstretched hand may result in an injury mostly to the lateral and long head of distal triceps tendon and an intact medial head tendon; however, direct injuries can involve full-thickness ruptures. Although a traumatic distal triceps tendon rupture occurs after a fall on an outstretched hand, radial neck, capitellar, and medial collateral ligament injury can occur because of valgus load and remnant extensor mechanisms. Based on our finding, the clinician encountering a distal triceps tendon rupture due to a fall on an outstretched hand should be aware of the possibility of remaining elbow extensor mechanism by intact medial head tendon portion, and associated injuries, which may induce latent complications. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Ji Ho Lee
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kee Baek Ahn
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kwi Ryun Kwon
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - Kyung Chul Kim
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
| | - In Hyeok Rhyou
- J. H. Lee, K. B. Ahn, K. C. Kim, I. H. Rhyou, Department of Orthopedic Surgery, Upper Extremity and Microsurgery Center, SM Christianity Hospital, Pohang, South Korea
- K. R. Kwon, Department of Radiology Semyeong Christianity Hospital, Pohang, South Korea
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Gibbons LJ, Towers MJ. 'Tricep tear instead of Tricep Curl': Management in the Emergency Department. Int Emerg Nurs 2018; 38:50-55. [PMID: 29398475 DOI: 10.1016/j.ienj.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/28/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Lynda J Gibbons
- Our Lady's Hospital, Navan, Ireland; UCD School of Nursing Midwifery & Health Systems, Ireland; Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Ireland.
| | - Mark J Towers
- Our Lady's Hospital, Navan, Ireland; Our Lady of Lourdes Hospital, Drogheda, Ireland
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Beazley JC, Lawrence TM, Drew SJ, Modi CS. Distal Biceps and Triceps Injuries. Open Orthop J 2017; 11:1364-1372. [PMID: 29290876 PMCID: PMC5721327 DOI: 10.2174/1874325001711011364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 01/26/2023] Open
Abstract
Background: Rupture of the distal biceps and triceps tendons are relatively uncommon injuries typically occurring in middle-aged males as a result of eccentric loading of the tendon. Methods: A literature search was performed and the authors’ personal experiences reported. Results: This review discusses the diagnosis, indications and guidelines for management of these injuries and provides a description of the authors’ preferred operative techniques. Conclusion: Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.
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Affiliation(s)
- James C Beazley
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Thomas M Lawrence
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Steven J Drew
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
| | - Chetan S Modi
- Coventry and Warwickshire Shoulder and Elbow Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, CV2 2DX, UK
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Celli A. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair. Musculoskelet Surg 2015; 99 Suppl 1:S57-S66. [PMID: 25957546 DOI: 10.1007/s12306-015-0359-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management.
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Affiliation(s)
- A Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy.
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Abstract
OBJECTIVE To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. DATA SOURCES The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. MAIN RESULTS After a fall on an outstretched hand, direct trauma on the elbow, or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. CONCLUSIONS Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.
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Abstract
Biceps and triceps tendon ruptures are rather uncommon injuries and are most commonly diagnosed clinically. Magnetic resonance imaging can help the clinician to differentiate an incomplete tear and define any degeneration of the tendon. Surgical anatomical repair is typically performed in acute complete ruptures whereas nonoperative treatment can be used for partial ruptures, as well as for patients unfit for surgery. Single incision techniques are associated with a higher rate of nerve injuries, while double incision repairs have a higher prevalence of heterotopic ossification. Although various fixation methods have been applied including bone tunnels, interference screws, suture anchors, cortical button fixation, the current evidence does not support the superiority of one method over the other. A well-planned postoperative rehabilitation programme is essential for a good final outcome. As better fixation devices are being used, more aggressive rehabilitation programmes have been applied. Epidemiology, clinical evaluation, diagnosis, surgical and conservative management of these injuries are presented in this review along with the authors' preferred technique for the anatomical repair of acute complete ruptures.
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Affiliation(s)
- Zinon T Kokkalis
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.
| | - Efstathios G Ballas
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Panayotis N Soucacos
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
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Kokkalis ZT, Mavrogenis AF, Spyridonos S, Papagelopoulos PJ, Weiser RW, Sotereanos DG. Triceps brachii distal tendon reattachment with a double-row technique. Orthopedics 2013; 36:110-6. [PMID: 23379659 DOI: 10.3928/01477447-20130122-03] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Case reports and small series have reported variable results regarding the treatment of choice for patients with triceps brachii tendon ruptures. Early surgical repair has been recommended for acute complete ruptures of the triceps brachii distal tendon to prevent late functional disability. However, controversy exists regarding the optimum surgical technique of reattachment. In addition, various attachment techniques have been described, with none shown clinically to be superior. Therefore, the authors present a technique for triceps brachii distal tendon reattachment following acute complete ruptures and evaluate their results in a series of patients.
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Affiliation(s)
- Zinon T Kokkalis
- First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, 41 Ventouri St, 15562 Holargos, Athens, Greece.
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Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res 2012; 98:242-6. [PMID: 22381568 DOI: 10.1016/j.otsr.2011.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/24/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
Distal brachii triceps tendon rupture is rare. Partial lesions are not so well defined. If functionally they are well tolerated in patients with low functional demand, management guideline is not so clear for sportsmen. To our best knowledge, there is no reported technique for the repair of partial forms. A 28-year-old patient was operated on for a partial triceps rupture. He underwent a transosseous olecranon suture of the tricipital tendon, with a side-to-side suture to the healthy residual tendon. The patient was assessed at 2 years follow-up with the DASH score. He had painless and mobile elbow with no effusion and returned to sport 4 months after his surgical repair. The extension strength was comparable to the healthy side (5/5). The DASH score was 1,7 for global score, and 6,3 for work and sport modules. Partial rupture of brachii triceps tendon is not well tolerated in high functional demand patients. We think that patients should be operated in these situations and may achieve excellent results. Postoperative management is crucial to achieve good results as well as in complete rupture.
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Yoon MY, Koris MJ, Ortiz JA, Papandrea RF. Triceps avulsion, radial head fracture, and medial collateral ligament rupture about the elbow: a report of 4 cases. J Shoulder Elbow Surg 2012; 21:e12-7. [PMID: 22005123 DOI: 10.1016/j.jse.2011.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/16/2011] [Accepted: 06/25/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Michele Y Yoon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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12
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Ruptures and avulsions of the distal tendon of the triceps brachii. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0818-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2011; 40:587-94. [PMID: 20953605 DOI: 10.1007/s00256-010-1043-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/10/2010] [Accepted: 09/21/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Petre BM, Grutter PW, Rose DM, Belkoff SM, McFarland EG, Petersen SA. Triceps tendons: a biomechanical comparison of intact and repaired strength. J Shoulder Elbow Surg 2011; 20:213-8. [PMID: 21145757 DOI: 10.1016/j.jse.2010.08.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/27/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Our hypothesis was that the autograft-augmented direct repair of torn triceps tendons would have strength superior than that of direct repair when compared to the strength of intact distal triceps tendons. MATERIALS AND METHODS The strength of the intact distal triceps tendon in 8 unpaired, fresh frozen cadaver specimens was measured to tendon failure by uniaxial tension in the sagittal plane. The torn triceps tendons were then repaired by direct repair (sutures through drill holes) or an autograft-augmented direct repair. Each tendon repair was biomechanically tested to failure, and load to displacement curves and the site of tendon failure were recorded. Tendon strength after each repair was compared with that of the other repair technique and with that of the intact triceps tendon. Significance was set at P < .05. RESULTS Average failure loads for intact, direct repair, and augmented repair tendons were 1741, 317, and 593 N, respectively; augmented repairs were significantly stronger than direct repairs. In the intact tendon, failure occurred at the insertion site through a tear at the bone tendon interface or through a small cortical avulsion. In the repaired tendons, all but 1 failure occurred through the suture; 1 augmented repair failed first at the tendon and then through the suture. DISCUSSION There is a paucity of clinical data regarding the optimal repair for distal triceps avulsion. We found that triceps repair affords less strength than the intact tendon, but augmented repair was nearly twice as strong as that of direct repair. Augmented repair may allow earlier range of motion, weightbearing, and rehabilitation, theoretically decreasing complications associated with the procedure. CONCLUSIONS Augmented triceps repair is superior to direct triceps repair for a distal triceps avulsion produced in a cadaver model.
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Affiliation(s)
- Benjamin M Petre
- International Center for Orthopaedic Advancement and Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2010. [PMID: 20953605 DOI: 10.1007/s00256- 010-1043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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Daglar B, Delialioglu OM, Ceyhan E, Altas O, Bayrakci K, Gunel U. Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass. Strategies Trauma Limb Reconstr 2009; 4:35-9. [PMID: 19340521 PMCID: PMC2666829 DOI: 10.1007/s11751-009-0057-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 03/16/2009] [Indexed: 11/29/2022] Open
Abstract
Triceps tendon ruptures are rare injuries. Coexistence of ipsilateral ulnar collateral ligament injury is even rarer. Here, we describe an unusual combination injury to elbow of a 39-year-old male construction worker consisting of triceps tendon rupture, avulsion of elbow ulnar collateral ligament and flexor pronator muscle origin ipsilaterally. A simultaneous repair and reconstruction of all damaged structures was proposed with individualized postoperative rehabilitation. Return to pre-injury level of activities obtained with this treatment protocol. High degree of suspicion and careful examination were needed to prevent missed diagnosis and prolonged instability which may be inevitable after inappropriate treatment of such injury.
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Affiliation(s)
- Bulent Daglar
- 4th Clinic of Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey,
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