Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joseph W. Bergman ◽  
Anelise Silveira ◽  
Robert Chan ◽  
Michael Lapner ◽  
Kevin A. Hildebrand ◽  
...  
Keyword(s):  
Return To Work ◽  
Distal Biceps ◽  
Early Return ◽  
Distal Biceps Repair ◽  
Cortical Button

scholarly journals Biomechanics of the Proximal Radius Following Drilling of the Bicipital Tuberosity to Mimic Cortical Button Distal Biceps Repair Technique

Hand ◽  
2017 ◽  
Vol 13 (3) ◽  
pp. 331-335 ◽  
Author(s):  
Nikhil R. Oak ◽  
John R. Lien ◽  
Alexander Brunfeldt ◽  
Jeffrey N. Lawton
Keyword(s):  
Bone Tunnel ◽  
Compression Testing ◽  
Fourth Generation ◽  
Proximal Radius ◽  
Distal Biceps ◽  
Cortical Defect ◽  
Torsional Testing ◽  
Distal Biceps Repair ◽  
Cortical Button ◽  
Bicipital Tuberosity

Background: A fracture through the proximal radius is a theoretical concern after cortical button distal biceps fixation in an active patient. The permanent, nonossified cortical defect and medullary tunnel is at risk during a fall eliciting rotational and compressive forces. We hypothesized that during simulated torsion and compression, in comparison with unaltered specimens, the cortical button distal biceps repair model would have decreased torsional and compressive strength and would fracture in the vicinity of the bicipital tuberosity bone tunnel. Methods: Sixteen fourth-generation composite radius Sawbones models were used in this controlled laboratory study. A bone tunnel was created through the bicipital tuberosity to mimic the exact bone tunnel, 8 mm near cortex and 3.2 mm far cortex, made for the BicepsButton distal biceps tendon repair. The radius was then prepared and mounted on either a torsional or compression testing device and compared with undrilled control specimens. Results: Compression tests resulted in average failure loads of 9015.2 N in controls versus 8253.25 N in drilled specimens ( P = .074). Torsional testing resulted in an average failure torque of 27.3 Nm in controls and 19.3 Nm in drilled specimens ( P = .024). Average fracture angle was 35.1° in controls versus 21.1° in drilled. Gross fracture patterns were similar in compression testing; however, in torsional testing all fractures occurred through the bone tunnel in the drilled group. Conclusion: There are weaknesses in the vicinity of the bone tunnel in the proximal radius during biomechanical stress testing which may not be clinically relevant in nature. Clinical Relevance: In cortical button fixation, distal biceps repairs creates a permanent, nonossified cortical defect with tendon interposed in the bone tunnel, which can alter the biomechanical properties of the proximal radius during compressive and torsional loading.

Return to work following a distal biceps repair: a systematic review of the literature

2020 ◽  
Vol 29 (5) ◽  
pp. 1002-1009 ◽  
Author(s):  
Luc Rubinger ◽  
Max Solow ◽  
Herman Johal ◽  
Jamal Al-Asiri
Keyword(s):  
Systematic Review ◽  
Return To Work ◽  
Review Of The Literature ◽  
Distal Biceps ◽  
Distal Biceps Repair

scholarly journals Distal Biceps Tendon Repair Using A Single-incision Approach With Unicortical Intramedullary Button Fixation: Report Early Post-operative Outcomes And Complications

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Kenneth M. Lin ◽  
Justin Chan ◽  
Brian J. Lin ◽  
Christopher L. Camp ◽  
Grant Hoerig Garcia ◽  
...  
Keyword(s):  
Heterotopic Ossification ◽  
Single Incision ◽  
Biceps Tendon ◽  
Tendon Repair ◽  
Distal Biceps Tendon ◽  
Distal Biceps ◽  
Distal Biceps Repair ◽  
Cortical Button ◽  
Biceps Tendon Repair

Objectives: While various techniques for distal biceps repair have been described, biomechanical studies have shown cortical button fixation to outperform bone tunnels, intraosseous screws, and suture anchors. Furthermore, numerous studies have shown no difference in complication rate between single- and dual-incision approaches. Thus, it follows that a single-incision approach with cortical button fixation may provide superior clinical outcomes with minimal complications. The purpose of this study is first to investigate intra-operative and short-term complications of distal biceps tendon repair through a single-incision approach using unicortical button fixation, and secondly to assess clinical outcomes. Methods: 52 patients who underwent distal biceps repair with unicortical button fixation (Figure 1) at a single institution from 2014 to 2017 were identified. Exclusion criteria included age less than 18 or greater than 75 years, prior ipsilateral biceps repair, concomitant ipsilateral surgical procedure, and most recent follow-up less than 2 months. Postoperative nerve deficits, flexion and supination strength by manual testing, range of motion, Mayo Elbow Performance Score (MEPS) and radiographs for identification of heterotopic ossification (HO) were obtained and analyzed retrospectively. Results: Fifty-two patients with 53 distal biceps ruptures were included, with mean age 48 years (range 25-71 years). Median time from injury to surgery was 2 weeks (range 1 day to 16 weeks), with 15 patients being treated at greater than 3 weeks from injury. Forty-four patients (83%) had complete tears. Following surgery, average time to final follow-up was 22.8 weeks (range 8-65 weeks). Postoperatively, 49 patients (92.5%) had full range of motion, 48 patients (90.6%) had return of full supination and flexion strength by manual muscle testing (the remaining patients had strength graded as 5-/5). There was no difference in outcomes between those patients treated < 3 weeks from injury compared to those treated > 3 weeks from injury. Two patients (3.8%) initially reported sensory deficit in the lateral antebrachial cutaneous nerve distribution, both cases of which fully resolved by 7 and 11 weeks postoperative. Two patients (3.8%) displayed radiographic evidence of heterotopic ossification, Hastings and Graham class I (Figure 2). One of these was an incidental finding without any clinical symptoms, the other had mild pain but normal strength and neurovascular function. Mean postoperative MEPS was 93.9 (range 60-100), corresponding to “excellent” function (MEPS>90). Conclusion: Distal biceps repair using single incision, unicortical button fixation yields a low rate of complications with good clinical results compared to other techniques reported in the literature. The single incision approach in patients treated between 3 and 16 weeks from injury is safe and resulted in outcomes no different than in those patients treated <3 weeks from injury. Further investigation is warranted in the form of larger, comparative studies with more robust outcome measures and longer term follow up. [Figure: see text][Figure: see text]

Distal Biceps Repair Using Cortical Button Fixation

2008 ◽  
Vol 16 (3) ◽  
pp. 130-135 ◽  
Author(s):  
Paul M. Sethi ◽  
James E. Tibone
Keyword(s):  
Distal Biceps ◽  
Distal Biceps Repair ◽  
Cortical Button

scholarly journals Return to Work and Sport Following Distal Triceps Repair

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0037
Author(s):  
Brandon Manderle ◽  
Evan Polce ◽  
Brady Williams ◽  
Gregory Nicholson ◽  
John Fernandez ◽  
...  
Keyword(s):  
Return To Work ◽  
Surgical Intervention ◽  
Nerve Repair ◽  
Return To Sport ◽  
Intensity Level ◽  
Postoperative Function ◽  
Distal Biceps ◽  
Distal Biceps Repair ◽  
Competitive Athletes

Objectives: Outcomes following distal triceps repair are important in order to properly counsel patients on expected postoperative function. Of particular interest are metrics regarding return to work and return to sport, including when return can be expected and at what intensity level. The purpose of this study is to establish important return to sport and work expectations for patients undergoing distal biceps repair. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2004 with minimum 2-year follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups. Mayo Elbow Performance Score (MEPS) and The Disabilities of the Arm, Shoulder and Hand Score (QuickDASH) were collected preoperatively and at final follow up. T-tests and chi-squared analysis was used to examine continous and categorical outcome variables, respectively. Results: A total of 70 patients (41 male) were contacted for final follow-up information. Average age was 48.42 + 13.32 and average time from initial injury to surgical intervention was 3.12 + 2.88 months. 81% of the injuries involve lifting of heavy objects, and 27.7% occurred during sport. Ten percent (n=7) of patients returned to the operating room, most commonly for ulnar nerve repair. Return to work was achieved in 86.3% of patients, occurring at an average of 2.87 months. Heavy duty status workers returned at significantly later time points than sedentary or light duty status workers (5.35 vs. 1.21 months, p<0.01). 81.4% of patients returned to the same or higher level of work. Return to sport was achieved by 79.7% of patients at an average of 3.32 months. 73.9% of patients were either satisfied or very satisfied with their ability to work, and 68.6% were satisfied or very satisfied with their ability to play spots. All competitive athletes (n=11) returned to either the same or higher level of intensity following surgery. Conclusion: Surgical repair of a distal triceps injury results in reliable return to work and sport, with the majority of patients returning to the same physical intensity of work and the same intensity of sporting, respectively. Competitive athletes demonstrate particularly impressive results with heightened return to sport rates at the same or greater intensity level, suggesting motivation level may have a role in determining successful return to sport. Our data may be utilized to better inform the shared decision-making process between providers and patients when considering surgical intervention for distal triceps injuries.

scholarly journals Return to Work and Sport After Distal Biceps Repair

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0036
Author(s):  
Alexander Beletsky ◽  
Brandon J. Manderle ◽  
Joseph Liu ◽  
Benedict Uchenna Nwachukwu ◽  
Mark S. Cohen ◽  
...  
Keyword(s):  
Return To Work ◽  
Bench Press ◽  
Surgical Intervention ◽  
Return To Sport ◽  
Intensity Level ◽  
Heavy Duty ◽  
Postoperative Function ◽  
Distal Biceps ◽  
Distal Biceps Repair

Objectives: Outcomes following distal biceps repair are important to establish in order to properly counsel patients on expected postoperative function. Of particular interest are metrics regarding return to work and return to sport, including when return can be expected and at what intensity level. The purpose of this study is to establish important return to sport and work expectations for patients undergoing distal biceps repair. Methods: A prospectively maintained institutional database was retrospectively reviewed for all patients who underwent distal biceps repair since 2005 with minimum 24-month follow-up. A patient survey was conducted over phone with regard to preoperative and postoperative participation in sports, level of intensity, and maximum weight repetitions of barbell and dumbbell biceps curl, bench press, and consecutive push-ups. Results: A total of 49 patients (23 male) were contacted for final follow-up information. Average age was 54.38 + 13.49 and average time from initial injury to surgical intervention was 4.05 + 3.85 months. The dominant side was affected in 63.27% of cases. 32.65% of the injuries involve lifting of heavy objects, and 24.49% occurred during sport. Return to work was achieved in 85.71% of patients, occurring at an average of 1.41 months. Moderate and heavy duty status workers significantly differed from light and sedentary duty status patients in regard to average months to return to work (3.68 months vs. 0.53 months, P<0.001). 73.25% patients returned to the same or higher level of work. Return to sport was achieved by 89.80% of patients, and 44.89% returned to the same or higher intensity of sport. One-repetition maximum (ORM) an average of 15 pounds for barbell bench press and 27.5 pounds for dumbbell curls on the affected arm. Maximum consecutive pushups decreased by an average of 11.66. Time from injury to surgical intervention was found to be significantly associated with decreased push-up counts (P=0.019) and decreased days participating in sports per week (P=0.014) postoperatively. Conclusion: After surgical repair of distal biceps rupture, the majority of patients are able to return to work and sport. Those that work moderate and heavy duty status jobs tend to return at later dates, and patients with longer times to surgical invention have worse functional outcomes with respect to push-ups and frequency of sporting activities. These expected outcomes should be shared with patients to aid in decision making and communicate postsurgical expectations.

Sign in / Sign up

Export Citation Format

Share Document