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Haft M, MacKenzie JS, Shi BY, Ali I, Jenkins S, Nguyen D, van Riet R, Srikumaran U. Biomechanical strength of triceps tendon repairs: systematic review and meta-regression analysis of human cadaveric studies. Musculoskelet Surg 2024; 108:153-162. [PMID: 38713360 DOI: 10.1007/s12306-024-00817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 03/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE It is unclear which triceps tendon repair constructs and techniques produce the strongest biomechanical performance while minimizing the risk of gap formation and repair failure. We aimed to determine associations of construct and technique variables with the biomechanical strength of triceps tendon repairs. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for peer-reviewed studies on biomechanical strength of triceps tendon repairs in human cadavers. 6 articles met the search criteria. Meta-regression was performed on the pooled dataset (123 specimens). Outcomes of interest included gap formation, failure mode, and ultimate failure load. Covariates were fixation type; number of implants; and number of sutures. Stratification by covariates was performed. We found no association between fixation type and ultimate failure load; however, suture anchor fixation was associated with less gap formation compared with transosseous direct repair (β = - 1.1; 95% confidence interval [CI]:- 2.2, - 0.04). A greater number of implants was associated with smaller gap formation (β = - 0.77; 95% CI: - 1.3, - 0.28) while a greater number of sutures was associated with higher ultimate failure load ( β= 3; 95% CI: 21, 125). In human cadaveric models, the number of sutures used in triceps tendon repairs may be more important than the fixation type or number of implants for overall strength. If using a transosseous direct repair approach to repair triceps tendon tears, surgeons may choose to use more sutures in their repair in order to balance the risk of larger gap formation when compared to indirect repair techniques. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- M Haft
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - J S MacKenzie
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - B Y Shi
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - I Ali
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - S Jenkins
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - D Nguyen
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - R van Riet
- Department of Orthopedic Surgery, University Hospital Antwerp, Edegem, Belgium
| | - U Srikumaran
- Department of Orthopedic Surgery, The Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA
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Shivdasani K, Scheidt M, Anderson J, Okafor L, Garbis N, Salazar D. Full-thickness triceps tears misdiagnosed as olecranon bursitis: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:319-323. [PMID: 38706666 PMCID: PMC11065744 DOI: 10.1016/j.xrrt.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Affiliation(s)
- Krishin Shivdasani
- Corresponding author: Krishin Shivdasani, BS, MPH, Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL 60153, USA.
| | - Michael Scheidt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | | | - Lauren Okafor
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Nickolas Garbis
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
| | - Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL, USA
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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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Lee E, Stillson QA, Seidel HD, Bhattacharjee S, Koh JL, Strelzow JA, Shi LL. Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs. Hand (N Y) 2023; 18:1300-1306. [PMID: 35658641 PMCID: PMC10617476 DOI: 10.1177/15589447221095114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Distal triceps ruptures are rare, and complete ruptures are commonly treated with surgery. Studies of patients in small cohorts with distal triceps tear have reported outcomes and risk factors; however, large-scale data are scant. This study seeks to determine current trends, outcomes, and risk factors of distal triceps tears. METHODS Within a large insurance claims database, distal triceps repair patients were identified through Current Procedural Terminology coding with concomitant distal triceps International Classification of Diseases, 9th Revision/10th Revision diagnosis codes and 1-year active status before and after surgery. Demographics, total costs, 90-day complications, and revision rates within 1 year of index surgery were analyzed. Logistic regression was performed for revision and complication rates using sex, age, and comorbidities (anabolic steroid use, diabetes, ischemic heart disease, tobacco use, rheumatoid arthritis, and chronic kidney disease). RESULTS A total of 8143 patients were included in the cohort. Male patients and patients aged 40 to 59 years comprised most of the study population. The postoperative complication rate was 5.8%, and the 1-year revision rate was 2.6%. Male sex, age >60 years, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease were statistically significant risk factors for higher 90-day complication rates. Anabolic steroid use significantly increased the risk of surgical revision. CONCLUSIONS Distal triceps repairs in this large cohort study occur most frequently in men aged 40 to 59 years. Complications are generally low, with age >60 years, male sex, ischemic heart disease, rheumatoid arthritis, and chronic kidney disease as risk factors for 90-day complications and prior anabolic steroid use as a risk factor for 1-year revision surgery. This information can help to improve education and expectations of this procedure.
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Affiliation(s)
| | - Quinn A. Stillson
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Henry D. Seidel
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Jason L. Koh
- NorthShore University HealthSystem, Evanston, IL, USA
| | - Jason A. Strelzow
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
| | - Lewis L. Shi
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL, USA
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Welborn B, White CC, Bruce JR. Augmentation of triceps tendon repair with a bio-inductive collagen scaffold. BMJ Case Rep 2023; 16:e255469. [PMID: 37793840 PMCID: PMC10551870 DOI: 10.1136/bcr-2023-255469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
Two active, adult male patients, one with prior triceps rupture and direct repair, presented with traumatic rupture of the distal triceps tendon. MRI confirmed not only complete rupture with retraction in both, but also signal changes within the tendon, raising concern for healing potential and re-rupture. Surgical repair was performed using heavy, non-absorbable suture and suture anchors in the standard fashion, followed by augmentation with a bovine, bio-inductive collagen scaffold in order to increase tendon thickness and aid with healing capability. This technique is well described for rotator cuff repair augmentation but is a novel technique to the literature in the setting of triceps tendons repair. Both patients returned to full, preinjury activity without complication with sustained results at 3 and 3.5 years postoperatively.
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Affiliation(s)
- Benjamin Welborn
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Charles Cody White
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
| | - Jeremy R Bruce
- Department of Orthopaedic Surgery, The University of Tennessee Health Science Center, College of Medicine, Chattanooga, Tennessee, USA
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Pohl NB, Brush PL, Toci GR, Heinle JT, Thomas A, Hornstein J, Aita D, Beredjiklian P, Katt B, Fletcher D. Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study. Cureus 2023; 15:e43696. [PMID: 37724223 PMCID: PMC10505354 DOI: 10.7759/cureus.43696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvement following surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from the medical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) results and range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277). No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.
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Affiliation(s)
- Nicholas B Pohl
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Parker L Brush
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Gregory R Toci
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jeremy T Heinle
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Anna Thomas
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Joshua Hornstein
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daren Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Brian Katt
- Division of Hand Surgery, Hackensack Meridian Ocean Medical Center, Brick Township, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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7
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Geyer S, Kadantsev P, Bohnet D, Marx C, Vieider RP, Braun S, Siebenlist S, Lappen S. Partial ruptures of the distal triceps tendons show only slightly lower ultimate load to failure: a biomechanical study. BMC Musculoskelet Disord 2023; 24:590. [PMID: 37468862 PMCID: PMC10357868 DOI: 10.1186/s12891-023-06720-3] [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: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVE Partial ruptures of the distal triceps tendon are usually treated surgically from a size of > 50% tendon involvement. The aim of this study was to compare the ultimate load to failure of intact triceps tendons with partially ruptured tendons and describe the rupture mechanism. METHODS Eighteen human fresh-frozen cadaveric elbow specimens were randomly assigned to two groups with either an intact distal triceps tendon or with a simulated partial rupture of 50% of the tendon. A continuous traction on the distal triceps tendon was applied to provoke a complete tendon rupture. The maximum required ultimate load to failure of the tendon in N was measured. In addition, video recordings of the ruptures of the intact tendons were performed and analysed by two independent investigators. RESULTS A median ultimate load to failure of 1,390 N (range Q0.25-Q0.75, 954 - 2,360) was measured in intact distal triceps tendons. The median ultimate load to failure of the partially ruptured tendons was 1,330 N (range Q0.25-Q0.75, 1,130 - 1.470 N). The differences were not significant. All recorded ruptures began in the superficial tendon portion, and seven out of nine tendons in the lateral tendon portion. DISCUSSION Partial ruptures of the distal triceps tendon demonstrate a not statistically significant lower ultimate load to failure than intact tendons and typically occur in the superficial, lateral portion of the tendon. This finding can be helpful when deciding between surgical and conservative therapy for partial ruptures of the distal triceps tendon.
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Affiliation(s)
- Stephanie Geyer
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
- St. Vinzenz Kliniken Pfronten Im Allgäu, Pfronten, Germany
| | - Pavel Kadantsev
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Daniel Bohnet
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Christian Marx
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
| | - Romed P Vieider
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
| | - Sepp Braun
- UMIT - Private Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik, Private University Hall, Hall/Tirol, Austria
- Gelenkpunkt - Sports and Joint Surgery Innsbruck, Innsbruck, Austria
| | - Sebastian Siebenlist
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany.
| | - Sebastian Lappen
- Department of Sports Orthopeadics, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Straße 22, Munich, 81675, Germany
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Flores SE, Sheridan JR, Larson ES, Immerman I. Triceps Rupture After Olecranon Fixation with Proximal Ulna Plate and Suture Augmentation: A Case Report. JBJS Case Connect 2023; 13:01709767-202309000-00048. [PMID: 37590436 DOI: 10.2106/jbjs.cc.23.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
CASE Olecranon fractures treated with proximal ulna plate fixation and repairing the triceps with suture augmentation to the plate decrease the risk of "olecranon escape," but may lead to failure through triceps rupture. In this case report, a rare complication of triceps rupture occurred, and the patient underwent triceps repair. CONCLUSION When fixing olecranon fractures, surgeons should minimize triceps dissection for hardware placement. If subjected to significant force, a surgical insult to the tendon footprint for a better plate contact on the bone and the presence of suture augmentation may change the construct failure mechanism and result in triceps rupture as opposed to fracture redisplacement.
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Affiliation(s)
- Sergio Eduardo Flores
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
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9
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Alkhalfan YH, Jha G, Verma B, Coatwala A, Mishra A, Rasheed Ali Khan TM, Sinha A, Bollineni RL, Subbiah P. The Elbow's Achilles Heel: A Systematic Review and Meta-Analysis of Triceps Tendon Rupture and Repair Techniques. Cureus 2023; 15:e41584. [PMID: 37559858 PMCID: PMC10407265 DOI: 10.7759/cureus.41584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
Triceps tendon avulsion is a rare but debilitating condition and the least frequent of all tendon injuries, but it is receiving increasing attention in the literature. The most common mechanism of injury is resisted extension, which is typically seen in a fall onto an extended hand. Such injuries are easily overlooked and should be considered a differential diagnosis in all patients who describe pain and swelling at the posterior aspect of the elbow following a traumatic event. Non-operative management is the general principle for partial rupture as opposed to a variety of surgical treatments for a complete avulsion. The goal of this meta-analysis is to analyse the current literature on triceps avulsion and provide a detailed overview of the occurrence, diagnosis, treatment options and outcomes, comparison of various repair techniques, and consequences of this injury.
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Affiliation(s)
- Yousif H Alkhalfan
- Trauma and Orthopaedics, Guy's and St Thomas' National Health Service (NHS) Foundation Trust, London, GBR
| | - Gaurav Jha
- Trauma and Orthopaedics, Leicester Royal Infirmary, Leicester, GBR
| | - Bhawika Verma
- Medicine, Maharashtra University of Health Sciences, Mumbai, IND
| | - Aadila Coatwala
- Surgery, Mahatma Gandhi Mission Institute of Health Sciences, Mumbai, IND
| | - Aarushi Mishra
- Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Akatya Sinha
- Medicine, Mahatma Gandhi Mission Medical College, Mumbai, IND
| | | | - Praveen Subbiah
- Intensive Care Unit, Broomfield Hospital, Mid and South Essex National Health Service (NHS) Foundation Trust, Chelmsford, GBR
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Bartlett LE, Klein BJ, Daley A, Goodwillie A, Cohn RM. Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature. JBJS Rev 2023; 11:01874474-202306000-00008. [PMID: 37307343 DOI: 10.2106/jbjs.rvw.23.00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.
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Affiliation(s)
- Lucas E Bartlett
- Department of Orthopedic Surgery, Northwell Health, Donald and Barbara Zucker School of Medicine, Huntington Hospital, Huntinton, New York
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11
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OZTURK T, ERPALA F. A rare injury "goalkeeper's elbow:" a triceps tendon rupture. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Distal Triceps Tendon Tears: Magnetic Resonance Imaging Patterns Using a Systematic Classification. J Comput Assist Tomogr 2022; 46:224-230. [PMID: 35081601 DOI: 10.1097/rct.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate distal triceps tendon tear patterns using a systematic classification based on the tendon's layered structure. METHODS We retrospectively identified Magnetic resonance imaging (MRI) examinations with triceps tendon tears that underwent reconstructive surgery. Magnetic resonance images were reviewed independently by 2 musculoskeletal radiologists to determine tendon layer involvement and ancillary findings, including tear size, involvement of triceps lateral expansion, and presence of olecranon bursal fluid. Surgical reports were scrutinized for level of anatomic detail and correlation with imaging findings. RESULTS We identified 69 triceps tendon tears in 68 subjects (61 men, 7 women; mean age, 45 ± 12 years) who underwent surgical reconstruction. On MRI, the superficial layer was always involved with either a partial or full-thickness tear. The most common tear pattern was a combination of superficial layer full-thickness tear with deep layer partial tear (25 of 69 [36%]). Mean tear length was 24 ± 12 mm. We found no cases of isolated deep layer tears. Involvement of triceps lateral expansion and presence of bursal fluid correlated positively with tear severity of superficial and deep layers (P < 0.001). Detailed surgical correlation was limited, with only 9 of 69 (13%) of surgical reports containing information specifically addressing individual tendon layers. CONCLUSIONS Triceps tendon tears show tear patterns following its layered structure and can be assessed by MRI. Radiologists and surgeons are encouraged to describe tear patterns considering both superficial and deep tendon layers.
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13
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Agarwalla A, Gowd AK, Liu JN, Garcia GH, Jan K, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to Sport Following Distal Triceps Repair. J Hand Surg Am 2022; 48:507.e1-507.e8. [PMID: 35074247 DOI: 10.1016/j.jhsa.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 09/18/2021] [Accepted: 11/10/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport. METHODS Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation. RESULTS Out of 113 eligible patients who had a distal triceps repair, 81 patients (71.7%) were contacted. Sixty-eight patients (84.0%) who participated in sports prior to surgery were included at 6.0 ± 4.0 years after surgery, and the average age was 46.6 ± 11.5 years. Sixty-one patients (89.7%) resumed playing at least 1 sport by 5.9 ± 4.4 months following distal triceps repair. However, 18 patients (29.5%) returned to a lower level of activity intensity. The average postoperative Quick Disabilities of the Arm, Shoulder, and Hand; Mayo Elbow Performance; visual analog scale for pain; and Single Assessment Numerical Evaluation scores were 8.2 ± 14.0, 89.5 ± 13.4, 2.0 ± 1.7, and 82.2 ± 24.3, respectively. No patients underwent revision surgery at the time of final follow-up. CONCLUSIONS Distal triceps repair enables 89.7% of patients to return to sport by 5.9 ± 4.4 months following surgery. However, 29.5% of patients were unable to return to their preinjury level of activity. It is imperative that patients are appropriately educated to manage postoperative expectations regarding sport participation following distal triceps repair. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA
| | | | - Kyleen Jan
- School of Medicine, University of Illinois, Chicago, IL
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL
| | - Robert W Wysocki
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - John J Fernandez
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Mark S Cohen
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL
| | - Nikhil N Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL.
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14
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Kirchhoff K, Beirer M, Völk C, Buchholz A, Biberthaler P, Kirchhoff C. [Lesions of the triceps tendon : Diagnostics, management, treatment]. Unfallchirurg 2021; 125:73-82. [PMID: 34910226 DOI: 10.1007/s00113-021-01103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents a rare injury pattern in general. Distal tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injury. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan's syndrome. However, the most frequent trauma mechanism is a direct fall onto the extended forearm or a blow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient's age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.
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Affiliation(s)
- K Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - M Beirer
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland
| | - C Völk
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A Buchholz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - P Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - C Kirchhoff
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
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Triceps Rupture and Repair in a Healthy, Young Woman following Rock Climbing. Case Rep Orthop 2021; 2021:3340479. [PMID: 34840839 PMCID: PMC8616681 DOI: 10.1155/2021/3340479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 12/03/2022] Open
Abstract
Triceps tendon rupture in females is rare. In this case report, we present a young adult female patient with a distal triceps tendon rupture from bouldering treated with open surgical repair technique using a modified bone tunnel and suture anchor fixation technique. The diagnosis and technique for repair and postoperative rehabilitation are described. A review of the current literature of biomechanical and clinical outcomes of various repair techniques is also presented.
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16
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Tramer JS, Patel R, Kuhlmann NA, Muh SJ. Simultaneous, Ipsilateral Distal Biceps and Distal Triceps Rupture in Healthy Weight Lifter: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00021. [PMID: 34252056 DOI: 10.2106/jbjs.cc.20.00693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 38-year-old weight lifter presented with a complete distal biceps rupture with retraction and a near complete ipsilateral distal triceps tear sustained during the bench press exercise. The tendons were fixed operatively using a simultaneous posterior and anterolateral approach to the elbow. CONCLUSION Simultaneous, ipsilateral distal biceps and distal triceps tendon injury is a rare occurrence that leads to significant functional loss. Repair of distal biceps rupture using a single-incision technique with a cortical button and distal triceps using a double-row suture anchor repair was successful in restoring functional anatomy to our patient.
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17
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[Transosseous reconstruction of triceps tendon rupture : Surgical technique]. Unfallchirurg 2021; 124:1024-1031. [PMID: 34023923 PMCID: PMC8632856 DOI: 10.1007/s00113-021-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
Operationsziel Transossäre Rekonstruktion der Trizepssehne. Indikation Sämtliche Trizepssehnenrupturen, die eine spannungsfreie Rekonstruktion erlauben. Kontraindikation Retrahierte Trizepssehnenrupturen, die nach Mobilisation keine spannungsfreie Rekonstruktion erlauben. Operationstechnik Durch 2 sich kreuzende transossäre Kanäle erfolgt das Durchfädeln eines nichtresorbierbaren Fadens. Direkt im Footprint erfolgt zudem das Setzen eines Fadenankers. Durch den primären Faden erfolgt nach transossärem Shutteln am Footprint beginnend das Durchflechten der Sehne in Krackow-Nahttechnik und, erneut am Footprint angekommen, das erneute transossäre Shutteln sowie das körperferne Verknoten. Mit dem ersten Fadenpaar des Ankers erfolgen in ähnlicher Weise das Armieren der Sehne und anschließend das intratendinöse Verknoten. Durch ein Verknoten des zweiten Fadenpaares des Ankers auf den primären körperfernen Knoten kann der Anpressdruck auf das Avulsionsfragment erhöht werden. Alternativ kann mit den Fäden des Fadenankers eine Mason-Allen Naht-durchgeführt werden. Weiterbehandlung Die ersten 6 Wochen erfolgt die Nachbehandlung in einer „ROM brace“ mit einem stufenweisen Freigeben der Flexion. Nach 6 Wochen freie Flexion. Beginn mit Kräftigungsübungen nach 12 Wochen. Ergebnisse Autoren beschreiben gute Ergebnisse nach operativer Versorgung von Trizepssehnenrupturen. Im vorliegenden Fall wird 6 Monate postoperativ, ungeachtet von einem in der Literatur beschriebenen möglichen Extensionsdefizit, ein exzellentes Outcome mit freiem Bewegungsausmaß erreicht.
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Agarwalla A, Gowd AK, Jan K, Liu JN, Garcia GH, Naami E, Wysocki RW, Fernandez JJ, Cohen MS, Verma NN. Return to work following distal triceps repair. J Shoulder Elbow Surg 2021; 30:906-912. [PMID: 32771606 DOI: 10.1016/j.jse.2020.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/18/2020] [Accepted: 07/19/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the rate and duration of return to work in patients undergoing distal triceps repair (DTR). METHODS Consecutive patients undergoing DTR from 2009 to 2017 at our institution were retrospectively reviewed at a minimum of 1 year postoperatively. Patients completed a standardized and validated work questionnaire; a visual analog scale for pain; the Mayo Elbow Performance Score; the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire; and a satisfaction survey. RESULTS Of 113 eligible patients who underwent DTR, 81 (71.7%) were contacted. Of these patients, 74 (91.4%) were employed within 3 years prior to surgery (mean age, 46.0 ± 10.7 years; mean follow-up, 5.9 ± 3.9 years). Sixty-nine patients (93.2%) returned to work by 2.2 ± 3.2 months postoperatively. Sixty-six patients (89.2%) were able to return to the same level of occupational intensity. Patients who held sedentary-, light-, medium-, and high-intensity occupations were able to return to work at a rate of 100.0%, 100.0%, 80.0%, and 76.9%, respectively, by 0.3 ± 0.5 months, 1.8 ± 1.5 months, 2.5 ± 3.6 months, and 4.8 ± 3.9 months, respectively, postoperatively. Of the workers' compensation patients, 15 (75%) returned to work by 6.5 ± 4.3 months postoperatively, whereas 100% of non-workers' compensation patients returned to work by 1.1 ± 1.6 months (P < .001). Seventy-one patients (95.9%) were at least somewhat satisfied, with 50 patients (67.6%) reporting excellent satisfaction. Seventy-two patients (97.3%) would undergo the operation again if presented the opportunity. A single patient (1.4%) required revision DTR. CONCLUSIONS Approximately 93% of patients who underwent DTR returned to work by 2.2 ± 3.2 months postoperatively. Patients with higher-intensity occupations had an equivalent rate of return to work but took longer to return to their preoperative level of occupational intensity. Information regarding return to work is imperative in preoperative patient consultation to manage expectations.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Anirudh K Gowd
- Department of Orthopaedic Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Kyleen Jan
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, CA, USA
| | | | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL, USA
| | - Robert W Wysocki
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - John J Fernandez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Mark S Cohen
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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19
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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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20
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Alberta FG. CORR Insights®: 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; 479:790-791. [PMID: 33497063 PMCID: PMC8083935 DOI: 10.1097/corr.0000000000001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 01/31/2023]
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Abstract
Triceps tendon injuries are an uncommon clinical entity poorly described in the literature. This review discusses the spectrum of pathology, effective diagnosis, nonsurgical treatment, surgical treatment, rehabilitation, and surgical complications of triceps tendon injuries. Management of triceps tendinopathies depends on the mechanism of injury and the patient's motor examination. Triceps tendinopathies and partial tendon tears with intact strength can be managed conservatively with rest, ice, immobilization, nonsteroidal anti-inflammatory drugs, and physical therapy. If conservative management fails for 6 months or there are strength deficits on examination, surgery should be considered. Based on the current evidence, there are no clear guidelines for "best" surgical approach. Although rare, the most significant surgical complication to be concerned about is rerupture. Rerupture rate is 4.62% among the articles we reviewed.
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Affiliation(s)
- Kyle Casadei
- Henry Ford Health System, Michigan, Lake Orion, MI
| | - John Kiel
- Emergency Medicine and Sports Medicine, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
| | - Michael Freidl
- Orthopedic Surgery, University of Florida-Jacksonville College of Medicine, Jacksonville, FL
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22
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Use of Magnetic Resonance Imaging for Orthopedic Trauma and Infection in the Emergency Department. Top Magn Reson Imaging 2020; 29:331-346. [PMID: 33264273 DOI: 10.1097/rmr.0000000000000256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Conditions affecting the musculoskeletal system constitute a significant portion of medical emergencies in the United States, with traumatic injury and infection being two of the most common etiologies. Although physical examination and plain radiographs are often sufficient to guide diagnosis and treatment, there are myriad traumatic and infectious pathologies that are commonly missed or simply not detectable on plain radiographs. Advanced imaging is subsequently warranted for additional workup.Magnetic resonance imaging (MRI) has become an increasingly used imaging modality for musculoskeletal complaints in the emergency department due to its superior visualization of soft tissues, focal edematous changes, and occult osseous insults often not visible on plain radiographs. Although multiple studies have evaluated its utility in the workup of emergency musculoskeletal complaints, there remains a dearth of literature examining the use of MRI for certain occult diagnoses.Radiologists, emergency clinicians, and orthopedic surgeons must be knowledgeable of the indications for MRI in the emergency setting, as delayed diagnosis may contribute to increased morbidity and possibly mortality. This review summarizes the use of MRI in diagnoses relating to trauma or infection among patients presenting to the emergency department with a musculoskeletal complaint.
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Homen D, Domingo-Johnson EL, Helm JM, Schalow M, Zumwalt M. Triceps Tendon Rupture - A Novel Repair of an Uncommon Injury. J Orthop Case Rep 2020; 10:35-39. [PMID: 32953652 PMCID: PMC7476698 DOI: 10.13107/jocr.2020.v10.i02.1686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Triceps tendon rupture is a rare injury accounting for <1% of all tendon injuries with varying repair techniques described. We present this novel repair to supplement available literature and help optimize the clinical outcomes for affected patients. We report this technique because it is unique in that we augmented our surgical fixation with a subtle variation in the described technique by repairing the deep portion of the triceps tendon as a separate step, maximizing the recreation of the anatomic footprint of the triceps. Case Report The patient is a 70-year-old Caucasian male presenting with pain, swelling, and ecchymosis around the elbow after the episode of injury. He also complained of a painful popping sensation whenever he ranged the elbow and an inability to extend, with pain and weakness any time he attempted elbow extension. Radiographs reviewed at his initial visit revealed a small osseous fragment approximately 5 cm proximal to the olecranon tip. Subsequent MR imaging confirmed our suspicion, showing a complete tear of the triceps tendon with hematoma at its insertion site and tendon retraction approximately 3 cm proximally. With the diagnosis of triceps tendon rupture conformed, we took the patient for primary tendon repair using suture with bone bridge and suture anchor, using elements from described techniques. Our technique was unique in that we performed repair of the deep and superficial triceps attachments as separate steps, in an endeavor to improve the anatomic reconstruction of the footprint and biomechanical strength. Conclusions We combined findings from our review of the available literature with novel surgical techniques and suture design to maximize the patient outcome and minimize complications. The patient went on to have a very satisfactory functional recovery. We hope that this case report will complement the evidence-based care of these patients by orthopedic surgeons and lead to the best results possible.
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Affiliation(s)
- Dylan Homen
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - E L Domingo-Johnson
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - J Matthew Helm
- Department of Medicine, Texas Tech University Health Sciences Center School of Medicine, 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
| | - Melinda Schalow
- Department of Orthopaedic Surgery, Medical Office Bldg. 4102 24th St. Suite 407, Lubbock, Texas 79410, United States
| | - Mimi Zumwalt
- Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center (TTUHSC), 3601 4th St. Stop 9436, Lubbock, Texas 79430-9436, United States
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Abstract
Distal triceps ruptures are uncommon, usually caused by a fall on an outstretched hand or a direct blow. Factors linked to injury include eccentric loading of a contracting triceps, anabolic steroid use, weightlifting, and traumatic laceration. Risk factors include local steroid injection, hyperparathyroidism, and olecranon bursitis. Initial diagnosis can be complicated by pain and swelling, and a palpable defect is not always present. Plain radiographs can be helpful. MRI confirms the diagnosis and directs treatment. Incomplete tears can be treated nonsurgically; complete tears are best managed surgically. Good to excellent restoration of function has been shown with surgical repair.
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Gaviria M, Ren B, Brown SM, McCluskey LC, Savoie FH, Mulcahey MK. Triceps Tendon Ruptures: Risk Factors, Treatment, and Rehabilitation. JBJS Rev 2020; 8:e0172. [PMID: 32539261 DOI: 10.2106/jbjs.rvw.19.00172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Triceps tendon ruptures (TTRs) are rare and often occur as a result of falling on an outstretched hand, forceful eccentric contraction, direct trauma to the elbow, or lifting against resistance. TTRs are most commonly seen in middle-aged men, football players, and weightlifters. Radiography, ultrasonography, and magnetic resonance imaging may be utilized for diagnosis and to guide treatment. Acute partial TTRs may have good outcomes with nonoperative management. Surgery should be considered if nonoperative treatment is unsuccessful or if substantial musculotendinous retraction is present. Surgical repair is strongly recommended for complete TTRs.
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Affiliation(s)
- Manuela Gaviria
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Beth Ren
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Symone M Brown
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Leland C McCluskey
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
| | - Felix H Savoie
- Department of Orthopaedic Surgery (S.M.B., L.C.M., F.H.S., and M.K.M.), Tulane University School of Medicine (M.G. and B.R.), New Orleans, Louisiana
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Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong) 2019; 26:2309499018778364. [PMID: 29871547 DOI: 10.1177/2309499018778364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Injury to the distal triceps brachii tendon is rare. Imaging radiographs are used to confirm the findings of physical examination, classify the extent of injury, and guide treatment. Magnetic resonance imaging (MRI) is considered the gold standard of diagnostic imaging. However, no previous study has reported on the accuracy of differentiation between partial- and full-thickness triceps tendon tears. Our study's aim was to define the accuracy of MRI in differentiating partial- from full-thickness tear of the distal triceps tendon. We hypothesized that MRI has low accuracy in differentiating partial- from full-thickness tears. METHODS A total of eight patients with nine triceps tendon tears underwent surgical repair from 2011 to 2015. MRI of the elbows were retrospectively reviewed for the presence and type of tear, tendon involvement, and location of the tear, and later correlated with surgical findings. RESULTS Of the three surgically confirmed complete tears, MRI correctly reported a complete tear in all patients. Of the six partial tears confirmed at surgery, MRI correctly identified four tears. In two cases, MRI described a complete tear, but only a partial tear was noted at surgery. CONCLUSION False-positive MRI assessment of distal triceps injury is not rare. Surgeons should rely on clinical examination in assessing distal triceps tendon injury, with imaging studies providing an adjunctive role in the diagnosis and decision-making.
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Affiliation(s)
- Erica Kholinne
- 1 Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Hassan Al-Ramadhan
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | | | - Malak Q Alalwan
- 3 College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - In-Ho Jeon
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Dunn JC, Kusnezov N, Fares A, Kilcoyne K, Garcia E, Orr JD, Waterman BR. Outcomes of Triceps Rupture in the US Military: Minimum 2-Year Follow-up. Hand (N Y) 2019; 14:197-202. [PMID: 29199471 PMCID: PMC6436132 DOI: 10.1177/1558944717745499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to examine the subjective and objective midterm functional clinical outcomes of surgically repaired triceps injuries in a moderate- to high-demand population. METHODS The US Military Health System was queried to identify all surgically treated triceps tendon ruptures between 2008 and 2013. Primary endpoints included rates of rerupture, perioperative complications, or significant persistent elbow dysfunction; Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow score, and ability to do push-ups were also extracted. RESULTS Thirty-seven patients underwent triceps tendon repair with a mean follow-up of 49.8 ± 17.3 months (range: 26.8-80.2). The most common mechanisms of injury were military duties (27%), sporting activity (24%), or fall-related (21.6%), with most injuries occurring during an eccentric movement (54%). While 45% experienced occasional elbow pain postoperatively, only 1 patient (2.7%) had a rerupture. Despite this, at 2 years, 31 patients (84%) were able to return to full military duty. While 6 patients were discharged from military service, only 1 underwent medical separation while 5 retired for reasons unrelated to their triceps tendon rupture. Patient-reported outcomes were available for 14 patients at final follow-up. The average DASH and Mayo Elbow scores were 4.7 (SD ± 4.7, range: 0-15.9) and 85.4 (SD ± 11.7, range: 60-100), respectively. The cohort could perform mean 54.2 (range: 9-90) push-ups. In additional, 12 of 14 (85.7%) were satisfied with their elbow function. CONCLUSIONS The active duty cohort experienced excellent postoperative results with a high rate of return to military duty, despite nearly half of the patients recognizing some degree of activity-related, elbow pain.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Austin Fares
- Creighton University, Omaha, NE, USA,Austin Fares, School of Medicine, Creighton University, 3561 Howard Street, Omaha, NE 68105, USA.
| | - Kelly Kilcoyne
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Justin D. Orr
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
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Dimock RA, Kontoghiorghe C, Consigliere P, Salamat S, Imam MA, Narvani AA. Distal Triceps Rupture Repair: The Triceps Pulley-Pullover Technique. Arthrosc Tech 2019; 8:e85-e91. [PMID: 30899656 PMCID: PMC6408749 DOI: 10.1016/j.eats.2018.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 02/03/2023] Open
Abstract
Distal triceps rupture is an uncommon but debilitating injury, and surgical fixation is almost invariably warranted. A number of techniques have been described in the literature in which combinations of transosseous tunnels and bone anchors have been used. We describe a modification to existing techniques-the triceps pulley-pullover technique with all-suture anchors. This technique minimizes bone loss, while maximizing the bone-tendon contact area and creating a double-row repair to optimize strength and healing.
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Affiliation(s)
- Richard A.C. Dimock
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | | | - Paolo Consigliere
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Shadi Salamat
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
| | - Mohamed A. Imam
- Norfolk & Norwich University Hospitals, Norwich, United Kingdom
| | - A. Ali Narvani
- Rowley Bristow Unit, Ashford and St Peter's NHS Trust, Chertsey, United Kingdom
- Fortius Clinic, London, United Kingdom
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Caldwell PE, Evensen CS, Vance NG, Pearson SE. Distal Triceps Speed Bridge Repair. Arthrosc Tech 2018; 7:e907-e913. [PMID: 30258771 PMCID: PMC6153264 DOI: 10.1016/j.eats.2018.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 02/03/2023] Open
Abstract
Distal triceps ruptures are uncommon injuries resulting in loss of elbow extension strength and necessitating surgical repair to ensure optimal functional outcome. Traditional fixation techniques using running, locking sutures through the tendon secured through bone tunnels have been shown to poorly restore the anatomic footprint and are mechanically inferior to anatomic repairs. We endorse restoring the anatomic footprint of the distal triceps, similar to the well-researched rotator cuff repair model.
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Affiliation(s)
- Paul E. Caldwell
- Orthopaedic Research of Virginia, Richmond, Virginia, U.S.A
- Tuckahoe Orthopaedic Associates, Richmond, Virginia, U.S.A
- Address correspondence to Paul E. Caldwell III, M.D., 1501 Maple Ave, Ste 200, Richmond, VA 23226, U.S.A.
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Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure. Case Rep Orthop 2018; 2018:7602096. [PMID: 30155330 PMCID: PMC6098857 DOI: 10.1155/2018/7602096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons. Case Report A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow. Discussion Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.
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Nwosu K, Schneiderman BA, Shymon SJ, Harris T. A Medial Malleolar "Fleck Sign" May Predict Ankle Instability in Ligamentous Supination External Rotation Ankle Fractures. Foot Ankle Spec 2018; 11:246-251. [PMID: 28877594 DOI: 10.1177/1938640017729494] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ankle joint stability dictates treatment in ligamentous supination external rotation ankle injuries (LSERAI). Investigation of the medial structures that support the ankle mortise is critical, and a small avulsion fracture, or "fleck", of the medial malleolus is occasionally encountered. This study aimed to assess the utility of this medial malleolus fleck sign (MMFS) in diagnosing instability requiring surgery in LSERAI. METHODS This retrospective observational study examined 166 LSERAI at a single level I trauma center. A standardized diagnostic and treatment protocol for ankle fractures was followed. LSERAI at presentation were reported as having a normal, dynamically wide, or statically wide medial clear space. Patient demographics, MMFS characteristics, and the use of operative management were recorded. RESULTS MMFS incidence in the cohort was 16 (10%) of 166 and was present in 25% of patients with unstable LSERAI. Fifteen (94%) of 16 patients with a MMFS were deemed to have an unstable LSERAI (P < .005). MMFS had a 25% sensitivity and 99% specificity in diagnosing an unstable LSERAI. For the subgroup of patients without a statically wide medial clear space, MMFS had a 50% sensitivity and 99% specificity in determining instability. CONCLUSION A MMFS may be indicative of an unstable LSERAI. With previous MRI studies demonstrating complete deltoid disruption in unstable LSERAI, we deduce the MMFS may be associated with extensive deltoid incompetence. The MMFS may help to diagnose a complete deltoid injury in LSERAI with a normal medial clear space, which could influence treatment and reduce patient morbidity, radiation exposure, and healthcare costs. LEVELS OF EVIDENCE Level III: Retrospective Cohort Study.
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Affiliation(s)
- Kenneth Nwosu
- Los Angeles County Harbor-UCLA Medical Center, Torrance, California
| | | | | | - Thomas Harris
- Los Angeles County Harbor-UCLA Medical Center, Torrance, California
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Mirzayan R, Acevedo DC, Sodl JF, Yian EH, Navarro RA, Anakwenze O, Singh A. Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases. Am J Sports Med 2018; 46:1451-1458. [PMID: 29578750 DOI: 10.1177/0363546518757426] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair. HYPOTHESIS No difference exists in the retear rate between TO and A repairs. Study Designed: Cohort study; Level of evidence, 3. METHODS All patients who underwent an open primary repair of a traumatic triceps tendon avulsion within 90 days of injury, between 2007 and 2015, were retrospectively reviewed. Surgeries were performed within a multisurgeon (75 surgeons), multicenter (14 centers), community-based integrated health care system. Patient demographic information, type of repair, complications, and time from surgery to release from medical care were recorded. RESULTS 184 triceps tears in 181 patients met the inclusion criteria. The mean age was 49 years (range, 15-83 years). There were 169 males. The most common mechanisms of injury were fall (56.5%) and weight lifting (19%). Mean time from injury to surgery was 19 days (range, 1-90 days); in 74.5% of cases, surgery was performed in 3 weeks or less. There were 105 TO and 73 A repairs. No significant difference was found between the two groups in the mean age ( P = .18), sex ( P = .51), completeness of tears ( P = .74), tourniquet time ( P = .455), and prevalence of smokers ( P = .64). Significant differences were noted between TO and A repairs in terms of reruptures (6.7% vs 0%, respectively; P = .0244), overall reoperation rate (9.5% vs 1.4%; P = .026), and release from medical care (4.3 vs 3.4 months; P = .0014), but no difference was seen in infection rate (3.8% vs 0%; P = .092). No difference was noted in release from medical care in patients who underwent surgery 3 weeks or less after injury compared with those undergoing surgery more than 3 weeks after injury (3.90 vs 4.09 months, respectively; P = .911). CONCLUSION Primary repair of triceps ruptures with TO fixation has a significantly higher rerupture rate, higher reoperation rate, and longer release from medical care than does repair with A fixation. Implementation of suture anchors in triceps repairs offers a lower complication rate and earlier release from medical care.
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Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente Southern California, Baldwin Park, California, USA
| | - Daniel C Acevedo
- Kaiser Permanente Southern California, Panorama City, California, USA
| | - Jeffrey F Sodl
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Edward H Yian
- Kaiser Permanente Southern California, Orange County, California, USA
| | - Ronald A Navarro
- Kaiser Permanente Southern California, South Bay, California, USA
| | | | - Anshuman Singh
- Kaiser Permanente Southern California, San Diego, California, USA
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Edelman D, Ilyas AM. Triceps Tendon Anatomic Repair Utilizing the "Suture Bridge" Technique. J Hand Microsurg 2018; 10:166-171. [PMID: 30483027 DOI: 10.1055/s-0038-1636729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 01/20/2018] [Indexed: 01/17/2023] Open
Abstract
Triceps tendon ruptures are uncommon injuries, but they typically require surgical repair. Multiple primary repair techniques are available, including transosseous, suture anchor, and anatomic repairs. The technique described here, the "suture bridge" repair, provides an anatomic repair of the distal triceps tendon to its footprint. It has the potential advantages of increased load to failure, better footprint coverage, higher load resistance, and allows for early motion.
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Affiliation(s)
- David Edelman
- Sidney Kimmel Medical College of the Thomas Jefferson University, Philadelphia, Pennsylvania, United States
| | - Asif M Ilyas
- The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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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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Horneff JG, Aleem A, Nicholson T, Lervick G, Murthi A, Sethi P, Getz C, Lazarus MD, Ramsey ML, Abboud JA, Tashjian R. Functional outcomes of distal triceps tendon repair comparing transosseous bone tunnels with suture anchor constructs. J Shoulder Elbow Surg 2017; 26:2213-2219. [PMID: 29032989 DOI: 10.1016/j.jse.2017.08.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Distal triceps tendon ruptures are relatively rare. Few studies have investigated functional outcomes after repair. There is no consensus on fixation methods for this injury. The purpose of this study was to compare the functional outcomes and the reoperation rates after distal triceps tendon repairs using transosseous tunnels and suture anchors. METHODS A multicenter, retrospective review of all primary triceps repairs done between 2006 and 2015 was performed. Patients were included if they had a minimum of 2 years of follow-up. Intraoperative data recorded included repair method and number of anchors used when applicable. Patients were contacted for functional assessment with the Mayo Elbow Performance Score (MEPS). Postoperative complications were also queried. RESULTS There were 56 cases of primary triceps repair identified in an all-male cohort. Average age at time of surgery was 52.7 years; 58.9% of patients had transosseous repair, and 41.1% had suture anchor repair. The average follow-up was 4.26 years. The average postoperative MEPS score for all patients was 94. There was no difference in MEPS outcomes based on construct type. Postoperative Disabilities of the Arm, Shoulder, and Hand scores had an overall average of 4.81. A statistically significant difference was found, with the transosseous group averaging 2.98 points lower than the suture anchor group. This difference was not found to be clinically relevant. Only 4 patients had rerupture of the triceps requiring revision. CONCLUSIONS Primary repair of distal triceps tendon ruptures yields good, durable patient outcomes with minimal rerupture regardless of repair construct.
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Affiliation(s)
- John G Horneff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Alexander Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Thema Nicholson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory Lervick
- Department of Orthopaedic Surgery, Twin Cities Orthopaedics, Minneapolis, MN, USA
| | - Anand Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Paul Sethi
- Department of Orthopaedic Surgery, ONS Sports and Shoulder Service, Greenwich, CT, USA
| | - Charles Getz
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mark D Lazarus
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Matthew L Ramsey
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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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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Dunn JC, Kusnezov N, Fares A, Rubin S, Orr J, Friedman D, Kilcoyne K. Triceps Tendon Ruptures: A Systematic Review. Hand (N Y) 2017; 12:431-438. [PMID: 28832209 PMCID: PMC5684929 DOI: 10.1177/1558944716677338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR. METHODS A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates. RESULTS The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month. Renal disease (10%) and anabolic steroid use (7%) were the 2 most common medical comorbidities. The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation. CONCLUSIONS TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Austin Fares
- Creighton University, Omaha, NE, USA,Austin Fares, School of Medicine, Creighton University, 3561 Howard Street, Omaha, NE 68105, USA.
| | - Sydney Rubin
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Justin Orr
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Darren Friedman
- New York Presbyterian Hospital-Weill Cornell Medical College, NY, USA
| | - Kelly Kilcoyne
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
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Scheiderer B, Lacheta L, Imhoff AB, Siebenlist S. V-shaped double-row distal triceps tendon repair: a novel technique using unicortical button fixation. Eur J Med Res 2017; 22:9. [PMID: 28292324 PMCID: PMC5351271 DOI: 10.1186/s40001-017-0250-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/06/2017] [Indexed: 08/21/2023] Open
Abstract
Background This report was designed to present a novel technique combining suture anchor and unicortical button fixation for distal triceps tendon repair. Technical description For anatomical reinsertion of an acute distal triceps tendon rupture, two suture anchors and one unicortical button forming a V-shaped configuration were used. The operative approach is described in detail. Results Excellent clinical and functional results were achieved in the early postoperative phase. The patient reached full elbow range of motion and extension muscle strength (5/5) compared to the uninjured arm 12 weeks after surgery. Complications did not occur. Conclusion This is the first report using unicortical button fixation in distal triceps tendon repair with promising preliminary results. Level of evidence Technical description, case report, Level V
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Affiliation(s)
- Bastian Scheiderer
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Lucca Lacheta
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Abstract
Distal triceps ruptures are rare injuries due to the special anatomical features of the muscle and tendon–bone junction. This injury typically occurs at the tendon–bone junction due to an eccentric contraction of the muscle. The treatment is controversial, especially in partial ruptures; surgical repair is indicated for complete ruptures of the distal triceps tendon. Several repair techniques have been described for acute complete ruptures. Chronic ruptures often require reconstruction rather than direct repair.
Cite this article: Demirhan M, Ersen A. Distal triceps ruptures. EFORT Open Rev 2016;1:255-259. DOI: 10.1302/2058-5241.1.000038.
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Elbow Ultrasound. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0182-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Aunon-Martin I, Prada-Canizares A, Jimenez-Diaz V, Vidal-Bujanda C, Leon-Baltasar JL. Treatment of a Complex Distal Triceps Tendon Rupture With a New Technique: A Case Report. ARCHIVES OF TRAUMA RESEARCH 2016; 5:e32221. [PMID: 27148500 PMCID: PMC4853493 DOI: 10.5812/atr.32221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
Introduction: The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. Case Presentation: In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. Conclusions: The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.
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Affiliation(s)
- Ismael Aunon-Martin
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
- Corresponding author: Ismael Aunon-Martin, Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain. Tel: +35-913908227, E-mail:
| | - Alfonso Prada-Canizares
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Veronica Jimenez-Diaz
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Carlos Vidal-Bujanda
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
| | - Jose Luis Leon-Baltasar
- Orthopedic Trauma Section, Orthopedic Surgery Department, October 12 Hospital, Madrid, Spain
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Zumstein MA, Bürki A, Massy AS, Zysset P, Moor BK. Extra-articular step osteotomy of the olecranon: A biomechanical assessment. Clin Biomech (Bristol, Avon) 2015; 30:1043-8. [PMID: 26443882 DOI: 10.1016/j.clinbiomech.2015.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/09/2015] [Accepted: 09/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Trans-olecranon chevron osteotomies (COs) remain the gold standard surgical approach to type C fractures of the distal humerus. This technique is associated with a high complication rate and development of an extra-articular olecranon osteotomy may be advantageous. The aim of this study was to compare the load to failure of COs with extra-articular oblique osteotomies (OOs) as well as modified, extra-articular step osteotomies (SOs). METHODS These three osteotomies and their subsequent fixation utilizing a standardized tension band wiring technique were tested in 42 composite analog ulnae models at 20° and 70° of flexion. Triceps loading was simulated with a servo hydraulic testing machine. All specimens were isometrically loaded until failure. Kinematic and force data, as well as interfragmentary motion were recorded. RESULTS At 70°, CO failed at a mean load of 963 N (SD 104 N), the OO at 1512 N (SD 208 N) and the SO at 1484 N (SD 153 N), (P<0.001). At 20°, CO failed at a mean load of 707 N (SD 104 N) and OO at 1009 N (SD 85 N) (P=0.006). The highest load to failure was observed for the SO, which was 1277 N (SD 172 N). The load to failure of the SO was significantly higher than the CO as well as the OO. CONCLUSION Extra-articular osteotomies showed a significantly higher load to failure in comparison to traditional CO. At near full extension (20° of flexion), this biomechanical advantage was further enhanced by a step-cut modification of the extra-articular oblique osteotomy.
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Affiliation(s)
- Matthias A Zumstein
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland.
| | - Alexander Bürki
- Institute for Surgical Technology and Biomechanics, University of Berne, Stauffacherstrasse 78, Bern, Switzerland
| | - Anne-Sophie Massy
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland
| | - Philippe Zysset
- Institute for Surgical Technology and Biomechanics, University of Berne, Stauffacherstrasse 78, Bern, Switzerland
| | - Beat K Moor
- Department of Orthopaedic Surgery and Traumatology, University of Bern, Insel Hospital, Switzerland
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Neumann H, Schulz AP, Breer S, Faschingbauer M, Kienast B. Traumatic Rupture of the Distal Triceps Tendon (A Series of 7 Cases). Open Orthop J 2015; 9:536-41. [PMID: 26664499 PMCID: PMC4671227 DOI: 10.2174/1874325001509010536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/01/2015] [Accepted: 09/11/2015] [Indexed: 12/12/2022] Open
Abstract
Even non-traumatic ruptures of the triceps tendon are rare, surgical therapy should be recommended in all
cases, because of poor results after non-operative treatment. A golden standard for the surgical procedure is not
established. A small series of traumatic distal tendon ruptures was treated surgical in our hospital and was followed up
after 12 months concerning their function. Very good and good results could be found with a strong reintegration of the
tendon by using transosseus sutures with non resorbable suture material. The refixation with suture anchors showed
disappointing results with early pull-outs of the anchor. Revision with screw augmentation with a washer had to be
performed. Concerning the biomechanical forces, which show up on the olecranon (up to 40 NM), the refixation of the
triceps tendon has proved to be extremely resistant against pull out forces. The good results by using non absorbable
transosseus sutures led to a standardized procedure in our trauma center, even the rupture is not traumatic.
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Affiliation(s)
- H Neumann
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - A-P Schulz
- Department of Traumatology & Orthopaedics, University of Schleswig-Holstein, Campus Lübeck, Germany
| | - S Breer
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - M Faschingbauer
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany
| | - B Kienast
- Department of Traumatology, Orthopaedics and Sports Traumatology, BG Trauma Center Hamburg, Germany ; Department of Traumatology & Orthopaedics, University of Schleswig-Holstein, Campus Lübeck, Germany
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46
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Abstract
Acute triceps ruptures are an uncommon entity, occurring mainly in athletes, weight lifters (especially those taking anabolic steroids), and following elbow trauma. Accurate diagnosis is made clinically, although MRI may aid in confirmation and surgical planning. Acute ruptures are classified on an anatomic basis based on tear location and the degree of tendon involvement. Most complete tears are treated surgically in medically fit patients. Partial-thickness tears are managed according to the tear severity, functional demands, and response to conservative treatment. We favor an anatomic footprint repair of the triceps to provide optimal tendon to bone healing and, ultimately, functional outcome.
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Affiliation(s)
- Jay D Keener
- Department of Orthopaedic Surgery, Washington University, CB# 8233, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Paul M Sethi
- The ONS Sports and Shoulder Service, 6 Greenwich Office Park, Greenwich, CT 06831, USA
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47
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Abstract
In caring for athletes, the physician must be able to accurately diagnose and appropriately treat all forms of elbow injuries. Traumatic injuries to the elbow are common in the athlete. The late cocking phase of throwing produces tremendous valgus stress on the elbow that can lead to medial epicondyle avulsion fractures in adolescents or rupture of the medial ulnar collateral ligament in skeletally mature overhead throwers, such as baseball pitchers and javelin throwers. Common traumatic elbow injuries suffered by athletes, surgical techniques for operative repair of these injuries, as well as postoperative rehabilitation protocols and the clinical results are presented.
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Affiliation(s)
- Lauren H Redler
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, 535 East 70th Street, New York, NY 10021, USA.
| | - Joshua S Dines
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, 535 East 70th Street, New York, NY 10021, USA
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48
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Simultaneous Bilateral Rupture of the Triceps Tendon in a Renal Transplant Patient. Case Rep Orthop 2015; 2015:903690. [PMID: 26366314 PMCID: PMC4558418 DOI: 10.1155/2015/903690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 08/12/2015] [Indexed: 11/30/2022] Open
Abstract
The unilateral rupture of the triceps brachii tendon is a rare lesion representing 1% of all tendon injuries. The most common causes are the result of a contraction against resistance (especially weightlifters) and direct trauma. It has also been associated with systemic diseases such as diabetes mellitus, chronic renal failure, secondary hyperparathyroidism, and use of systemic corticosteroids. Simultaneous bilateral rupture of the triceps tendons is less frequent and has been described in association with chronic metabolic disorders, especially in those patients on hemodialysis. This paper presents a case of bilateral triceps tendon rupture of a 36-year-old woman with renal transplantation secondary to chronic renal failure. Early surgical repair was performed using a bone tunnel technique with a nonabsorbable suture. Clinically active extension with 135 degrees of range of motion was achieved.
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49
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Abstract
Complete triceps tendon rupture is relatively rare, but more commonly seen in the athletic population. Loss of extension strength is the functional deficit for the elbow after rupture of the triceps tendon. Although partial tears may be treated conservatively, complete tears of the triceps tendon must be repaired to provide active extension at the elbow. Our preferred surgical technique for repair of the acute triceps tendon rupture is presented, as well as strategies for reconstruction of the triceps tendon with an Achilles tendon allograft.
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Affiliation(s)
- James B Bennett
- Department of Orthopedic Surgery, and Division of Plastic Surgery, Baylor College of Medicine, Houston, TX.
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50
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Kose O, Kilicaslan OF, Guler F, Acar B, Yuksel HY. Functional outcomes and complications after surgical repair of triceps tendon rupture. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1131-9. [PMID: 26164405 DOI: 10.1007/s00590-015-1669-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/03/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to present the functional outcomes and complications after primary repair of triceps tendon ruptures (TTR). PATIENTS AND METHODS A retrospective review was performed on eight patients (six males, two females) who underwent transosseous suture repair for TTR. Mayo elbow score, range of motion, muscle strength and patient satisfaction were evaluated after at least 1-year follow-up. RESULTS The mean age of the patients was 25.1 years (range 16-42). The mechanism of injury was a sports injury in three patients, simple fall (fall on outstretched hand) in four and motorcycle accident in one patient. Two patients had associated radial head fracture, and one had a radial head fracture and trochlear fracture, and one patient had a medial epicondyle fracture. In two patients the diagnosis was missed at the initial admission to ED (delay, 20 and 75 days). Only one patient, who was a bodybuilder, had a history of anabolic steroid use, and the rest had no underlying disease or a predisposing factor for TTR. One of the patients with radial head fracture (displaced three parts) underwent simultaneous fixation using two headless screws. Patients were followed up for a mean of 18.8 months (range 12-26). At the final follow-up, all patients were satisfied with the treatment and the Mayo elbow score was excellent in six patients and good in two patients. There was 5° extension loss in two patients. Triceps muscle strength was 5/5 in all patients. Ulnar nerve entrapment occurred in one patient, so ulnar nerve release and anterior transposition were performed 3 months after surgery. Posterior interosseous nerve palsy occurred in one patient who underwent simultaneous radial head fracture fixation, but eventually returned back to normal 3 months postoperatively. All patients returned to their previous level of activity and occupation. CONCLUSION Transosseous suture technique is a safe and effective treatment method for acute TTR with a low rate of complications and excellent functional outcomes. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Ozkan Kose
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey.
| | - Omer Faruk Kilicaslan
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Ferhat Guler
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Baver Acar
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
| | - Halil Yalçın Yuksel
- Department of Orthopedics and Traumatology, Antalya Education and Research Hospital, Uncalı mahallesi Toroslar caddesi, Samut Comfort Palace E Blok No: 2, Konyaaltı, Antalya, Turkey
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