| Popis: |
Goal: to present a new method of transosseous distal biceps tendon fixation in case of acute tendon rupture. Material and methods: 40 years old male with acute distal biceps tendon rupture was surgicaly treated using transosseous suture. A single anterior transverse incision, 4 cm distal to the elbow crease, was used. After the tendon was retrieved and distal portion of the tendon debrided, Krakow suture was placed on the distal 5 cm of the tendon and diameter of tendon measured. Unicortical tunnel was drilled over radial tuberosity reaching opposite cortex and width corresponding tendon diameter. Then, with arm in maximal supination and medial wall of the tunnel exposed, two small holes were drilled into the tunnel for suture passage. Suture ends were passed in inside-out fashion through small holes and tendon pulled into the tunnel. With arm in 90 degrees of flexion and maximum supination tendon was tensioned and sutures placed on anterior cortex. Postoperatively, arm was immobilized in upper arm orthosis and physical therapy started immediately. Results: The functional outcome was evaluated with DASH score. There was significant improvement in physical function and symptoms preoperatively and 3 months postoperatively, with DASH score increase from 10 to 65, respectively. Conclusion: Transosseous reinsertion of the ruptured distal biceps tendon at the tuberosity of the radius is the recommended method of repair. Number of fixation methods described in literature use single incision implant fixation or two incision suture fixation. While implant fixation is more expensive, suture fixation is technically more demanding procedure carrying risk of posterior interosseus nerve injury. Our transosseous technique is a simple, safe and reproducible method giving minimal morbidity and good functional result. It is single incision procedure with unicortical tunnel placement that provides strong fixation and good bone-tendon interface with no implant use. |
