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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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2
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Medina G, Keller RE, Sabbag OD, Oh LS. Terrible triad of the elbow and associated variants: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:205-213. [PMID: 37587951 PMCID: PMC10426655 DOI: 10.1016/j.xrrt.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background The terrible triad of the elbow (TTE) is a complex injury consisting of simultaneous elbow dislocation or subluxation, radial head fracture, and coronoid fracture. During the initial assessment of a TTE, the typical severity of presenting pain, swelling, and limited range of motion may limit the ability to perform a thorough physical examination and thus divert a clinician's attention away from additional injuries to the ipsilateral upper extremity. Therefore, the purpose of this study was to review the literature for reported cases of concomitant ipsilateral upper extremity injuries associated with a TTE and discuss various strategies to increase clinician awareness to avoid underdiagnosis and missed diagnoses. Methods A systematic review of five databases in four languages (English, Spanish, French, and Portuguese), from inception to May 2021, was conducted. Articles describing a TTE with a concomitant osseous, chondral, ligamentous, or musculotendinous injury occurring on the ipsilateral upper extremity were included. The patients were divided into two groups, those presenting with a classic TTE and concomitant ipsilateral upper extremity injury (group 1) and those in whom a TTE variant was described (group 2). A TTE variant was defined as a combination of osseous and/or chondral injuries to the elbow other than the classic description of TTE, in which at least two of the three classical elements of a TTE (elbow dislocation, coronoid fracture, and radial head fracture) were present in addition to other unique elbow osteoarticular injury. Results Nineteen articles met inclusion criteria and were further analyzed. A total of 27 patients were analyzed, 23 from group 1 and 4 from group 2. Overall, 33 concomitant injuries were documented in group 1, the most common being an olecranon fracture (27.3%), followed by Essex-Lopresti injury, triceps tendon avulsion, and carpal fracture-dislocation with 4 (12.1%) cases each. Group 2 had four patients, all of whom presented with a unique variant of the classically described TTE. Conclusion Despite a characteristic radiographic appearance of the classic TTE, additional injuries of the ipsilateral extremity or variants of the classic TTE may be easily missed, especially in cases resulting from high-energy mechanisms of injury. By analyzing the available data on associated injuries and variants that may occur with a TTE, we hope to increase awareness so that clinicians may recognize these less common but more complex injury patterns.
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Affiliation(s)
- Giovanna Medina
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel E. Keller
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Orlando D. Sabbag
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Luke S. Oh
- Sports Medicine Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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3
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Pelvic floor muscle injury during a difficult labor. Can tissue fatigue damage play a role? Int Urogynecol J 2021; 33:211-220. [PMID: 34783861 DOI: 10.1007/s00192-021-05012-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 10/19/2022]
Abstract
Pubovisceral muscle (PVM) injury during a difficult vaginal delivery leads to pelvic organ prolapse later in life. If one could address how and why the muscle injury originates, one might be able to better prevent these injuries in the future. In a recent review we concluded that many atraumatic injuries of the muscle-tendon unit are consistent with it being weakened by an accumulation of passive tissue damage during repetitive loading. While the PVM can tear due to a single overstretch at the end of the second stage of labor we hypothesize that it can also be weakened by an accumulation of microdamage and then tear after a series of submaximal loading cycles. We conclude that there is strong indirect evidence that low cycle fatigue of PVM passive tissue is a possible mechanism of its proximal failure. This has implications for finding new ways to better prevent PVM injury in the future.
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4
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Willaume T, Bierry G. Biceps, Brachialis, and Triceps. Semin Musculoskelet Radiol 2021; 25:566-573. [PMID: 34706386 DOI: 10.1055/s-0041-1735466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.
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Affiliation(s)
- Thibault Willaume
- MSK Radiology, University Hospital of Strasbourg, Strasbourg, France
| | - Guillaume Bierry
- MSK Radiology, University Hospital of Strasbourg, Strasbourg, France
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5
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Vila Pouca MCP, Parente MPL, Jorge RMN, Ashton-Miller JA. Injuries in Muscle-Tendon-Bone Units: A Systematic Review Considering the Role of Passive Tissue Fatigue. Orthop J Sports Med 2021; 9:23259671211020731. [PMID: 34395681 PMCID: PMC8361535 DOI: 10.1177/23259671211020731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Low-cycle fatigue damage accumulating to the point of structural failure has been recently reported at the origin of the human anterior cruciate ligament under strenuous repetitive loading. If this can occur in a ligament, low-cycle fatigue damage may also occur in the connective tissue of muscle-tendon units. To this end, we reviewed what is known about how, when, and where injuries of muscle-tendon units occur throughout the body. Purpose: To systematically review injuries in the muscle-tendon-bone complex; assess the site of injury (muscle belly, musculotendinous junction [MTJ], tendon/aponeurosis, tendon/aponeurosis–bone junction, and tendon/aponeurosis avulsion), incidence, muscles and tendons involved, mechanism of injury, and main symptoms; and consider the hypothesis that injury may often be consistent with the accumulation of multiscale material fatigue damage during repetitive submaximal loading regimens. Methods: PubMed, Web of Science, Scopus, and ProQuest were searched on July 24, 2019. Quality assessment was undertaken using ARRIVE, STROBE, and CARE (Animal Research: Reporting In Vivo Experiments, Strengthening the Reporting of Observational Studies in Epidemiology, and the Case Report Statement and Checklist, respectively). Results: Overall, 131 studies met the inclusion criteria, including 799 specimens and 2,823 patients who sustained 3,246 injuries. Laboratory studies showed a preponderance of failures at the MTJ, a viscoelastic behavior of muscle-tendon units, and damage accumulation at the MTJ with repetitive loading. Observational studies showed that 35% of injuries occurred in the tendon midsubstance; 28%, at the MTJ; 18%, at the tendon-bone junction; 13%, within the muscle belly and that 6% were tendon avulsions including a bone fragment. The biceps femoris was the most injured muscle (25%), followed by the supraspinatus (12%) and the Achilles tendon (9%). The most common symptoms were hematoma and/or swelling, tenderness, edema and muscle/tendon retraction. The onset of injury was consistent with tissue fatigue at all injury sites except for tendon avulsions, where 63% of the injuries were caused by an evident trauma. Conclusion: Excluding traumatic tendon avulsions, most injuries were consistent with the hypothesis that material fatigue damage accumulated during repetitive submaximal loading regimens. If supported by data from better imaging modalities, this has implications for improving injury detection, prevention, and training regimens.
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Affiliation(s)
- Maria C P Vila Pouca
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Marco P L Parente
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Renato M Natal Jorge
- Faculty of Engineering of University of Porto, Porto, Portugal.,Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - James A Ashton-Miller
- Departments of Mechanical and Biomedical Engineering, College of Engineering and School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
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6
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Najefi AA, Domos P. A unique case of bilateral triceps avulsion fracture in a patient with pseudohypoparathyroidism. Shoulder Elbow 2021; 13:334-338. [PMID: 34659475 PMCID: PMC8512989 DOI: 10.1177/1758573219876553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/10/2019] [Accepted: 08/14/2019] [Indexed: 11/17/2022]
Abstract
Triceps tendon ruptures and avulsions are rare injuries and are often associated with systemic diseases. This paper illustrates the unique case of a 20-year-old female patient with pseudohypoparathyroidism, who sustained bilateral triceps avulsion fractures after a fall. She underwent suture anchor fixation, augmented with tension band suture as double row repair with excellent post-operative results. We describe the pathophysiology of this injury and the unique method of fixation, which can be an alternative effective method to repair these injuries.
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Affiliation(s)
- Ali-Asgar Najefi
- Ali-Asgar Najefi, Trauma & Orthopaedic
Department, Royal Free Hospital NHS Trust, Barnet Hospital, Wellhouse Lane, Barnet EN5
3DJ, UK.
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7
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Dehghani Nazhvani H, Bemani Lirgeshasi S, Bahari M. Terrible Triad Elbow Fracture Dislocation with Ipsilateral Triceps Avulsion and Radial Shaft Fracture: A Case Report. JBJS Case Connect 2020; 10:e20.00308. [PMID: 33512924 DOI: 10.2106/jbjs.cc.20.00308] [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: 06/12/2023]
Abstract
CASE We report an unusual combination of injuries, terrible triad elbow fracture dislocation with ipsilateral avulsion of the triceps, and radial shaft fracture in a 23-year-old man. He was managed surgically and had good postoperative outcomes. CONCLUSION Evaluation of the triceps tendon avulsion injury is difficult in this context, such as problems evaluating the rotator cuff injuries after a shoulder fracture dislocation. Because of the diagnostic difficulty, a high index of suspicion is necessary.
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Affiliation(s)
- HamidReza Dehghani Nazhvani
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
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8
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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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Abstract
CLINICAL/METHODICAL ISSUE Muscular injuries represent the most common musculoskeletal lesions. Especially in professional athletes an imaging clarification is essential in order to define the exact location of the lesion, the affected muscles, the extent and degree of the injury as well as to define possible concomitant complications. The best possible therapy can be initiated and a necessary rest period for a low risk resumption of sporting activity can be individually specified. STANDARD RADIOLOGICAL METHODS/METHODICAL INNOVATIONS Due to technical improvements, for example mobile devices and thus increased rapid availability as well as relative cost-effectiveness compared to other modalities, the imaging evaluation of muscle injury would nowadays be unthinkable without ultrasound. PERFORMANCE The article discusses general prerequisites for the performance of muscle ultrasound as well as a standardized examination algorithm of muscle injuries beginning with general and leading to special tips and tricks. ACHIEVEMENTS/PRACTICAL RECOMMENDATIONS Despite the known investigator dependence, ultrasound enables a reliable and unerring imaging clarification of muscle injuries. For this reason, ultrasound should be considered as the first-line diagnostic imaging modality when dealing with muscle trauma.
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10
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Steffes M, Tayne S, Osmani F, Edwards G, MacGillis K, Kim W, Hammarstedt JE, Goldberg B. Triceps Repair and Restoration of Triceps Footprint With Anchorless Suture Fixation. Tech Hand Up Extrem Surg 2018; 22:89-93. [PMID: 29965949 DOI: 10.1097/bth.0000000000000196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Triceps tendon rupture is an uncommon yet potentially devastating injury affecting patients over a broad demographic. Surgical treatment is essential to restore upper extremity functional status, and a vast array of techniques has been implemented with different fixation devices including suture buttons, intraosseous anchors, and suture repairs. Outcomes of distal triceps tendon repair have demonstrated nearly full return of functional capacity. Complications include infection, ulnar nerve neuropathy, arthrofibrosis, flexion contracture, hardware irritation, and most commonly, repair failure. We illustrate a triceps repair technique with suture fixation that restores the tendinous footprint without need of an adjunctive device.
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Affiliation(s)
- Matthew Steffes
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Samantha Tayne
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Feroz Osmani
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Gary Edwards
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kyle MacGillis
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Walter Kim
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jon E Hammarstedt
- Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Benjamin Goldberg
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, IL
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11
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Giannicola G, Bullitta G, Rotini R, Murena L, Blonna D, Iapicca M, Restuccia G, Merolla G, Fontana M, Greco A, Scacchi M, Cinotti G. Results of primary repair of distal triceps tendon ruptures in a general population: a multicentre study. Bone Joint J 2018; 100-B:610-616. [PMID: 29701103 DOI: 10.1302/0301-620x.100b5.bjj-2017-1057.r2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aims The aim of the study was to analyze the results of primary tendon reinsertion in acute and chronic distal triceps tendon ruptures (DTTRs) in the general population. Patients and Methods A total of 28 patients were operated on for primary DTTR reinsertions, including 21 male patients and seven female patients with a mean age of 45 years (14 to 76). Of these patients, 23 sustained an acute DTTR and five had a chronic injury. One patient had a non-simultaneous bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture or dislocation. Comorbidities were present in four patients. Surgical treatment included transosseous and suture-anchors reinsertion in 22 and seven DTTRs, respectively. The clinical evaluation was performed using Mayo Elbow Performance Score (MEPS), the modified American Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities of the Arm, Shoulder and Hand score (QuickDASH), and the Medical Research Council (MRC) Scale. Results A total of 27 patients (28 DTTRs) were available for review at a mean of 47.5 months (12 to 204). The mean MEPS, QuickDASH, and m-ASES scores were 94 (60 to 100), 10 (0 to 52), and 94 (58 to 100), respectively. Satisfactory results were observed in 26 cases (93%). Muscle strength was 5/5 and 4/5 in 18 and ten DTTRs, respectively. One patient with chronic renal failure experienced a traumatic rerupture of distal triceps. One patient (1 DTTR) experienced mild elbow stiffness. Conclusion Primary repair of acute and chronic DTTRs in a general population yields satisfactory results in the majority of patients with a low rerupture rate. Cite this article: Bone Joint J 2018;100-B:610-16.
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Affiliation(s)
- G Giannicola
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome -PoliclinicoUmberto I, Rome, Italy
| | - G Bullitta
- Department of Anatomical, Histological,Forensic Medicine and Orthopedics Sciences,Sapienza University of Rome - PoliclinicoUmberto I
| | - R Rotini
- Shoulder and Elbow Surgery Unit, RizzoliOrthopedic Institute, Bologna, Bologna, Italy
| | - L Murena
- Clinical University Department of Medical,Surgical and Health Sciences, Orthopaedicsand Traumatology Clinic, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste,Università degli Studi di Trieste, Trieste, Italy
| | - D Blonna
- Orthopedics and Traumatology Department,Mauriziano-Umberto I Hospital, University ofTurin Medical School, Turin, Italy
| | - M Iapicca
- Department of Orthopaedic Surgery, AziendaOspedaliera Papa Giovanni XXIII, Bergamo, Bergamo, Italy
| | - G Restuccia
- S.O.D. Orthopaedics and Traumatology, AOUPAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - G Merolla
- Unit of Shoulder and Elbow Surgery, D. CervesiHospital, Cattolica-AUSL della RomagnaAmbito Territoriale di Rimini, Cattolica, Italy
| | - M Fontana
- Department of Orthopaedics andTraumatology, Ospedale degli Infermi, Faenza, Italy
| | - A Greco
- Department of Orthopaedics andTraumatology, Ospedale San Salvatore, L' Aquila, Italy
| | - M Scacchi
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
| | - G Cinotti
- Department of Anatomical, Histological andForensic Medicine, and Orthopaedic Sciences,Sapienza University of Rome - PoliclinicoUmberto I, Rome, Italy
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12
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Nocerino EA, Cucchi D, Arrigoni P, Brioschi M, Fusi C, Genovese EA, Messina C, Randelli P, Masciocchi C, Aliprandi A. Acute and overuse elbow trauma: radio-orthopaedics overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:124-137. [PMID: 29350642 PMCID: PMC6179073 DOI: 10.23750/abm.v89i1-s.7016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Summary. The correct management of acute, subacute and overuse-related elbow pathologies represents a challenging diagnostic and therapeutic problem. While major trauma frequently requires a rapid surgical intervention, subluxation and minor trauma allow taking more time for diagnostics and planning the correct elective treatment after careful clinical and radiological investigation. In these conditions, communication between orthopaedic surgeon and radiologist allow to create a detailed radiology report, tailored to the patient’s and surgeon’s needs and optimal to plan proper management. Imaging technique as X-Ray, CT, US, MRI, CTA and MRA all belong to the radiologist’s portfolio in elbow diagnostics. Detailed knowledge of elbow pathology and its classification and of the possibilities and limits of each imaging technique is of crucial importance to reach the correct diagnosis efficiently. The aim of this review is to present the most frequent elbow pathologies and suggest a suitable diagnostic approach for each of them. (www.actabiomedica.it)
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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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14
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Gupta RK, Soni A, Malhotra A, Masih GD. Triceps tendon reconstruction using autologous semitendinosis graft in professional kabaddi player-A rare case report. J Clin Orthop Trauma 2017; 8:S38-S40. [PMID: 28878538 PMCID: PMC5574866 DOI: 10.1016/j.jcot.2017.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Triceps tendon rupture is a rare injury occurs due to sudden forceful contraction of triceps against flexed elbow. Though there are case reports describing various treatment options for this injury, including primary repair as well as reconstruction using different technique, no standardised technique has been defined. We present, for the first time, a case of five month old neglected triceps tendon rupture in a professional kabaddi player. Ruptured tendon was reconstructed using free autologous semitendinous graft with good functional outcome.
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15
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Abstract
Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.
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Affiliation(s)
- Atin Jaiswal
- Department of Orthopaedics, Maya Hospital, India
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16
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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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17
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Celli A. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair. Musculoskelet Surg 2015; 99 Suppl 1:S57-S66. [PMID: 25957546 DOI: 10.1007/s12306-015-0359-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management.
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Affiliation(s)
- A Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy.
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18
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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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Abstract
Biceps and triceps ruptures are rare, but can cause significant disability. They typically result from a forceful eccentric contraction, resulting in weakness and pain. Biceps and triceps tendon injuries represent the most and least common tendinous injuries about the elbow, respectively. Nonoperative management of these injuries is generally reserved for partial ruptures or patients unfit for surgery. Surgical repair has become the preferred method of treatment for acute, complete ruptures. Anatomy, epidemiology, clinical evaluation, and treatment of these injuries are described in this review.
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20
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Abstract
OBJECTIVE To elucidate mechanism of injury, nonoperative protocols, surgical techniques, rehabilitation schedules, and return to sports guidelines for partial and complete triceps tendon injuries. DATA SOURCES The PubMed and OVID databases were searched in 2010 and peer-reviewed English language articles in 2011. MAIN RESULTS After a fall on an outstretched hand, direct trauma on the elbow, or lifting against resistance, patients often present with pain and weakness of extension. Examination may reveal a palpable tendon gap, and radiographs may reveal a Flake sign. Acute partial injuries have positive outcomes with immobilization in 30-degree flexion for 4 to 6 weeks. Primary repair for complete rupture can restore normal extensor function after 3 to 4 months. Reconstruction returns normal extensor function up to 4 years. Most authors support postoperative immobilization for 2 to 3 weeks at 30- to 40-degree flexion, flexion block bracing for an additional 3 weeks, and unrestricted activity at 6 months. Athletes may be able to return to sports after 4 to 5 weeks of recovery from a partial injury, but return may be delayed if operative tendon repair is performed. CONCLUSIONS Acute partial triceps tendon injuries may be managed conservatively at first and should be repaired primarily if this fails or if presentation is delayed. Reconstruction should first use the anconeus rotation technique. If the anconeus is devitalized, the Achilles tendon may be the allograft of choice.
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21
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22
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Canbora K, Ozyurek S, Gumussuyu G, Kose O. Triceps tendon avulsion and associated injuries of the elbow. BMJ Case Rep 2013; 2013:bcr-2013-009460. [PMID: 23667221 DOI: 10.1136/bcr-2013-009460] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A rupture or avulsion of the triceps tendon is very rare but concomitant elbow injuries with avulsion of the triceps tendon are even rarer. In this study, an extraordinary and unusual injury combination (radial head and trochlear fracture associated with triceps tendon avulsion), which happened during a fall onto the elbow with outstretched hand, was identified and has been discussed in the literature.
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Affiliation(s)
- Kerem Canbora
- Department of Orthopaedics and Traumatology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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23
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Abstract
Olecranon fractures are common injuries of the upper extremity; majority are treated surgically. A variety of fixation techniques are available to surgeons in modern practice, but there is little comparative clinical research to guide one's decision. Nonetheless, good results over all are to be expected after surgical management. This article presents a review of the current understanding and available evidence in the treatment of olecranon fractures, their relevant anatomy, fracture patterns, fixation options, and outcomes.
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Affiliation(s)
- Nicolai Baecher
- Department of Orthopaedic Surgery, Georgetown University Hospital, Washington, DC 20007, USA
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24
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Abstract
Biceps and triceps tendon ruptures are rather uncommon injuries and are most commonly diagnosed clinically. Magnetic resonance imaging can help the clinician to differentiate an incomplete tear and define any degeneration of the tendon. Surgical anatomical repair is typically performed in acute complete ruptures whereas nonoperative treatment can be used for partial ruptures, as well as for patients unfit for surgery. Single incision techniques are associated with a higher rate of nerve injuries, while double incision repairs have a higher prevalence of heterotopic ossification. Although various fixation methods have been applied including bone tunnels, interference screws, suture anchors, cortical button fixation, the current evidence does not support the superiority of one method over the other. A well-planned postoperative rehabilitation programme is essential for a good final outcome. As better fixation devices are being used, more aggressive rehabilitation programmes have been applied. Epidemiology, clinical evaluation, diagnosis, surgical and conservative management of these injuries are presented in this review along with the authors' preferred technique for the anatomical repair of acute complete ruptures.
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Affiliation(s)
- Zinon T Kokkalis
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.
| | - Efstathios G Ballas
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Andreas F Mavrogenis
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Panayotis N Soucacos
- Department of Orthopaedics, Orthopaedic Research & Education Center, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
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25
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Kokkalis ZT, Mavrogenis AF, Spyridonos S, Papagelopoulos PJ, Weiser RW, Sotereanos DG. Triceps brachii distal tendon reattachment with a double-row technique. Orthopedics 2013; 36:110-6. [PMID: 23379659 DOI: 10.3928/01477447-20130122-03] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Case reports and small series have reported variable results regarding the treatment of choice for patients with triceps brachii tendon ruptures. Early surgical repair has been recommended for acute complete ruptures of the triceps brachii distal tendon to prevent late functional disability. However, controversy exists regarding the optimum surgical technique of reattachment. In addition, various attachment techniques have been described, with none shown clinically to be superior. Therefore, the authors present a technique for triceps brachii distal tendon reattachment following acute complete ruptures and evaluate their results in a series of patients.
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Affiliation(s)
- Zinon T Kokkalis
- First Department of Orthopaedics, Athens University Medical School, ATTIKON University Hospital, 41 Ventouri St, 15562 Holargos, Athens, Greece.
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26
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Abstract
Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury.
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27
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Clinical outcome after suture anchor repair for complete traumatic rupture of the distal triceps tendon. Arthroscopy 2012; 28:1058-63. [PMID: 22405915 DOI: 10.1016/j.arthro.2011.12.016] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 12/08/2011] [Accepted: 12/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical results of surgical repair of complete distal triceps tendon rupture using suture anchors and high-strength sutures by use of validated outcome measures. METHODS A consecutive series of traumatic distal triceps tendon ruptures at a single institution were studied. All cases were surgically repaired by use of suture anchors double loaded with ultrahigh-molecular-weight polyethylene-containing sutures. All patients were evaluated with a physical examination, radiographs, and questionnaires. The following postoperative validated outcome measures were used: the Disabilities of the Arm, Shoulder and Hand (DASH) score; the Oxford Elbow Score; the American Shoulder and Elbow Surgeons elbow assessment form; and the Mayo Elbow Performance Index. RESULTS Five male patients with a mean follow-up of 32 months underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the repairs, 3 were in the dominant arm and 2 in the nondominant arm. The mean patient age was 47 years (range, 35 to 54 years). Postoperatively, the mean DASH score was 1.4, the mean American Shoulder and Elbow Surgeons elbow score was 99.2, the mean Mayo Elbow Performance Index was 95.8, the mean Oxford Elbow Score for pain was 98.8, the mean Oxford Elbow Score for function was 100, and the mean Oxford Elbow Score for the social domain was 96.2. A lower score for the DASH indicates less disability and better function. CONCLUSIONS This retrospective case series of suture anchor repair of distal triceps tendon ruptures showed excellent elbow function based on validated clinical outcome measures. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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28
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Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res 2012; 98:242-6. [PMID: 22381568 DOI: 10.1016/j.otsr.2011.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/24/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
Distal brachii triceps tendon rupture is rare. Partial lesions are not so well defined. If functionally they are well tolerated in patients with low functional demand, management guideline is not so clear for sportsmen. To our best knowledge, there is no reported technique for the repair of partial forms. A 28-year-old patient was operated on for a partial triceps rupture. He underwent a transosseous olecranon suture of the tricipital tendon, with a side-to-side suture to the healthy residual tendon. The patient was assessed at 2 years follow-up with the DASH score. He had painless and mobile elbow with no effusion and returned to sport 4 months after his surgical repair. The extension strength was comparable to the healthy side (5/5). The DASH score was 1,7 for global score, and 6,3 for work and sport modules. Partial rupture of brachii triceps tendon is not well tolerated in high functional demand patients. We think that patients should be operated in these situations and may achieve excellent results. Postoperative management is crucial to achieve good results as well as in complete rupture.
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29
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Ruptures and avulsions of the distal tendon of the triceps brachii. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0818-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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30
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2011; 40:587-94. [PMID: 20953605 DOI: 10.1007/s00256-010-1043-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/10/2010] [Accepted: 09/21/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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31
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Lambers K, Ring D. Elbow fracture-dislocation with triceps avulsion: report of 2 cases. J Hand Surg Am 2011; 36:625-7. [PMID: 21463726 DOI: 10.1016/j.jhsa.2010.12.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 12/19/2010] [Accepted: 12/22/2010] [Indexed: 02/02/2023]
Abstract
We report 2 cases of elbow fracture dislocation with triceps avulsion. Despite immobilizing the elbow in neutral for 2 to 4 weeks to protect the triceps repair, good elbow motion was obtained.
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Affiliation(s)
- Kaj Lambers
- Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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32
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2010. [PMID: 20953605 DOI: 10.1007/s00256- 010-1043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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34
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Abstract
Distal triceps rupture is an uncommon injury. It is most often associated with anabolic steroid use, weight lifting, and laceration. Other local and systemic risk factors include local steroid injection, olecranon bursitis, and hyperparathyroidism. Distal triceps rupture is usually caused by a fall on an outstretched hand or a direct blow. Eccentric loading of a contracting triceps has been implicated, particularly in professional athletes. Initial diagnosis may be difficult because a palpable defect is not always present. Pain and swelling may limit the ability to evaluate strength and elbow range of motion. Although plain radiographs are helpful in ruling out other elbow pathology, MRI is used to confirm the diagnosis, classify the injury, and guide management. Incomplete tears with active elbow extension against resistance are managed nonsurgically. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Good to excellent results have been reported with surgical repair, and very good results have been achieved even for chronic tears.
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35
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Daglar B, Delialioglu OM, Ceyhan E, Altas O, Bayrakci K, Gunel U. Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass. Strategies Trauma Limb Reconstr 2009; 4:35-9. [PMID: 19340521 PMCID: PMC2666829 DOI: 10.1007/s11751-009-0057-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 03/16/2009] [Indexed: 11/29/2022] Open
Abstract
Triceps tendon ruptures are rare injuries. Coexistence of ipsilateral ulnar collateral ligament injury is even rarer. Here, we describe an unusual combination injury to elbow of a 39-year-old male construction worker consisting of triceps tendon rupture, avulsion of elbow ulnar collateral ligament and flexor pronator muscle origin ipsilaterally. A simultaneous repair and reconstruction of all damaged structures was proposed with individualized postoperative rehabilitation. Return to pre-injury level of activities obtained with this treatment protocol. High degree of suspicion and careful examination were needed to prevent missed diagnosis and prolonged instability which may be inevitable after inappropriate treatment of such injury.
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Affiliation(s)
- Bulent Daglar
- 4th Clinic of Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey,
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36
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Wolf JM, McCarty EC, Ritchie PD. Triceps reconstruction using hamstring graft for triceps insufficiency or recurrent rupture. Tech Hand Up Extrem Surg 2008; 12:174-179. [PMID: 18776780 DOI: 10.1097/bth.0b013e31817da1ba] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Triceps ruptures are relatively rare injuries. When they occur, primary surgical repair of the tendon to the proximal ulna is recommended. However, some patients require reconstruction using tendon grafting due to shortening or insufficiency of the native triceps tendon. Triceps ruptures associated with biological abnormalities (such as renal insufficiency or metabolic disease) or recurrence of rupture represent situations where a stout augmented repair is desirable. Multiple allograft and autologous tendons have been described for augmentation, but the use of gracilis and semitendinosus tendons provides superior length and size for use in triceps reconstruction. Using an illustrative case example, the evaluation of triceps insufficiency and the need for additional graft is shown. The technique of autologous hamstring augmentation for triceps insufficiency is described in detail. The importance of graded rehabilitation is emphasized with a complete program of triceps strengthening over time.
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37
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Langenhan R, Weihe R, Kohler G. [Traumatic rupture of the triceps brachii tendon and ipsilateral Achilles tendon]. Unfallchirurg 2008; 110:977-80. [PMID: 17571249 DOI: 10.1007/s00113-007-1282-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report on a 71-year-old male farmer who sustained an injury to the tendons of the triceps brachii and the Achilles tendon on the left side. The diagnosis was based on clinical investigations and ultrasound. The triceps brachii tendon was repaired with open transosseous sutures. Six weeks after the operation we only allowed passive mobilization. The Achilles tendon rupture was treated with a semi-open procedure. Four weeks after the operation the ankle was fixed in 30 degrees plantar flexion, followed by 2 weeks in neutral position. Full weight bearing was allowed. Six months after the operation the patient no longer had any problems with his injury. Injuries of the tendon of the triceps brachii are very rare, with an incidence of 0.8%. We could not find case reports of a simultaneous injury to another tendon in the literature.
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Affiliation(s)
- R Langenhan
- Klinik für Orthopädie und Traumatologie, Kantonsspital, Frauenfeld, Switzerland.
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38
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Abstract
The management of distal biceps and triceps ruptures is reviewed. Epidemiology, clinical presentation, evaluation, surgical management, nonoperative management, and rehabilitation rationale and techniques are presented. Although various surgical repair techniques are used, none has been shown to produce superior clinical outcomes. The literature is lacking information to provide evidence-based decisions regarding rehabilitation strategies. Prospective studies comparing types and timing of repairs and timing and techniques for a postoperative program are needed. As that information is not yet available, the rehabilitation plan outlined in this article is based on timetables for healing tissue, strength of repair, prevention of complications, consideration of patient's medical history and injury history, and review of the literature. Familiarity with the different treatment options assists the surgeon and therapist tailor a therapy program that is optimal for each individual patient.
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Affiliation(s)
- Susan M Blackmore
- The Philadelphia Hand Center, King of Prussia, Pennsylvania 19406, USA.
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39
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Tatebe M, Horii E, Nakamura R. Chronically ruptured triceps tendon with avulsion of the medial collateral ligament: a report of 2 cases. J Shoulder Elbow Surg 2006; 16:e5-7. [PMID: 17240294 DOI: 10.1016/j.jse.2005.12.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 12/07/2005] [Indexed: 02/01/2023]
Affiliation(s)
- Masahiro Tatebe
- Department of Hand Surgery, Nagoya University School of Medicine, 65 Tsurumaicho, Showaku, Nagoya 466-8550, Japan.
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40
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Yanmis I, Oğuz E, Atesalp AS, Ozkan H, Kürklü M, Demiralp B, Basbozkurt M. Application of Circular External Fixator under Arthroscopic Control in Comminuted Patella Fractures: Technique and Early Results. ACTA ACUST UNITED AC 2006; 60:659-63. [PMID: 16531873 DOI: 10.1097/01.ta.0000197929.74984.1a] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comminuted fractures of the patella are traditionally treated by internal fixation. The modified tension-band technique is widely accepted for internal fixation. The management of comminuted fractures often requires additional K-wire and/or circlage material and wide surgical exposure. Therefore, symptoms and complications related to the stainless steel wire are not uncommon in these cases. We present a new alternative treatment technique for comminuted patellar fractures. METHODS Five comminuted patellar fractures of four patients were treated by circular external fixator (CEF) under arthroscopic control. The mean patient age was 32.5 (range 24-41) years and mean follow-up was 22 (range 20-28) months. RESULTS In four cases, union was completed by the sixth week; in the other case, union was completed by the eighth week. The frames were removed after union of the fracture was documented. When the CEF was removed, full knee range of motion was observed full in all patients, and the patients returned to their normal activities of living in a few days. The mean Lysholm score was 94 (range 85-100) after treatment. CONCLUSIONS CEF application under arthroscopic control can help avoid some complications of the traditional treatment methods, particularly in comminuted fractures of the patella. The most important advantage of this technique is to allow active knee motion in the early postoperative period so patients can return to activity of daily living soon after the implant removal. In addition, arthroscopic examination of the knee joint provides an assessment of any other intra-articular lesions. This technique allows healing of the fracture with low morbidity.
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Affiliation(s)
- Ibrahim Yanmis
- Department of Orthopedic and Traumatology, Gülhane Military Medical Academy, and the Mevki Military Hospital, Ankara, Turkey.
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Greer MA, Miklos-Essenberg ME. Early mobilization using dynamic splinting with acute triceps tendon avulsion. J Hand Ther 2005; 18:365-71; quiz 371. [PMID: 16059858 DOI: 10.1197/j.jht.2005.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Avulsion of the triceps tendon is rare, and no previous report of a completed dynamic splinting rehabilitation plan was found in the literature. A case of a military member and power weightlifter who sustained a triceps tendon avulsion and repair is presented with a six-month follow-up. The rehabilitation program included early active elbow flexion and passive extension using a dynamic elbow splint. The Disabilities of the Arm, Shoulder and Hand (DASH) 1-3 questionnaire was used to monitor the patient's use of his right dominant arm while in the dynamic splint. The DASH scores indicated that he experienced improved use of his affected arm during the splinting period. The end result was a good return of function within 13 weeks and full resumption of work and bodybuilding activities in six months, three months earlier than others reported in the literature who were immobilized after surgery. 4,5.
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Sharma SC, Singh R, Goel T, Singh H. Missed diagnosis of triceps tendon rupture: a case report and review of literature. J Orthop Surg (Hong Kong) 2005; 13:307-9. [PMID: 16365498 DOI: 10.1177/230949900501300317] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rupture of the triceps tendon is an uncommon injury, probably the rarest of all tendinous ruptures. We present a case of missed diagnosis of triceps tendon rupture. Such diagnosis should be considered when a patient presents with pain and swelling at the back of the elbow after a fall on an outstretched hand.
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Affiliation(s)
- S C Sharma
- Department of Orthopaedics, Paraplegia and Rehabilitation, Pt BD Sharma PGIMS, Rohtak (Haryana), India
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43
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Abstract
Injuries to the biceps and triceps tendons about the elbow are relatively infrequent. Typically, they are traumatic events that occur as a result of a forceful eccentric contraction. Early recognition of these injuries and prompt intervention are the cornerstones to a successful outcome. Acute anatomic repair of complete injuries offers predictably good results. Conservative management, on the other hand, is typically reserved for partial injuries with little functional compromise, and for patients unfit for surgery. The challenges posed by chronic injuries can be addressed with a variety of surgical options. This article focuses on the timely identification and diagnosis of these injuries and specific indications and guidelines for their treatment.
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Affiliation(s)
- Armando F Vidal
- The Sports Medicine and Shoulder Service, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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