Distal biceps ruptures repair: Experience with 80 cases.

Abstract

INTRODUCTION AND OBJECTIVES\nRupture of distal biceps has a frequency of 1.2 cases per 100,000 population. Conservative treatment presents a loss in supination of 40% and flexion of 30%, like transfers to the brachialis. Our goal is to review our experience with anatomical reattachment.\n\n\nMATERIAL AND METHODS\nCohorts study. We analized an historic cohort, although recent, treated with double approach (Boyd-Anderson) compared to another prospective cohort (treated with single and double approach). Sample size of 80 patients. Mean age of 48.9±5.9years. We analyzed laterality, time to diagnosis, presurgery time, surgery time, approach, type of reintegration, rehabilitation time, Mayo Elbow Performance Score (MEPS), biomechanical study and complications. Follow up from 2 years to 7years.\n\n\nRESULTS\nTime for diagnosis was about 4days. Preoperative time: 12.2±6.4 days. Surgical time: 61.9±15.7minutes. We used the two-way surgical approach (Boyd-Anderson-Morrey) in 78.8% of patients, and the anterior surgical approach (Henry) in 21.2% of cases. Transosseous reinsertion was made in 45% of cases, with screw anchor in 40% and with cortical button in 15%. Rehabilitation time: 91±29.7 days. MEPS: 88±11.7 points. There was loss of flexor strength of 28±16.6%.\n\n\nCOMPLICATIONS\n1case of proximal radioulnar synostosis, 2 radial transient paralysis and 5 cases with residual stiffness. Hypothesis contrast: We reached best results in MEPS with double surgical approach (P=.009), with fewer complications (P=.008). We observed increased pain with cortical buttons (P<.05) and less surgical time if patient was operated before 1week (P=.03). Relative risk of 0.2 when we compared type of approach with radial nerve lesion risk, considering that double approach had less cases, what it would be consider as a protective factor.\n\n\nCONCLUSIONS\nIn our experience, we believe that anatomic reattachment is an effective treatment. Double surgical approach presents best result in MEPS, with fewer complications than with anterior approach.