Since 1993, 120 fractures of the humerus were treated by retrograde unreamed nailing. Operations were performed on simple, complex, compound and pathological fractures of the proximal three quarter of the humerus. On the proximal humerus, displaced two-part-fractures and occasionally three- or four-part-fractures were stabilized. In 110 cases a prototype of an unreamed humeral nail with deployable fins for proximal locking was employed. In another ten cases the new solid interlocking nail of the AO/ASIF was used. The operative procedure, rehabilitation program, complications and functional and radiological results are presented. Retrograde nailing offers a high patient comfort and good functional results (Constant-Score on average 87% of the opposite side). Complications were nail migration (8.3%), instability (3.8%), nonunions (5.8%) and iatrogenic fractures (5.8%). Patients with high grade osteoporosis, small proximal fragments and poor compliance have an increased rate of complications.
From May 1999 to November 2001 an anatomical attachment of a ruptured distal biceps tendon to the radial tuberosity was performed through a limited anterior approach in 8 male patients with an age of 37 to 47 years. Through a small incision in the cubital fossa (3-4 cm) the remaining synovial sheet of the biceps tendon was followed to insert absorbable anchor hooks into the radial tuberosity. The distal biceps tendon then was anatomically reattached. Instruments for arthroscopic Bankart-repair were used. There were no specific complications like neurovascular damage or significant functional impairment. The contour of the biceps muscle was restored in all cases. 3 out of 7 patients developed mild heterotopic ossifications without functional deficits. In our experience the presented technique is a possible minimal invasive procedure of distal biceps tendon repair without major complications and with good functional results.
Proximal ruptures. Ruptures of the long head of the M. biceps humeri are commonly caused by degenerative changes within the tendon. Non-operative treatment gives good results, the loss of power regarding elbow flexion and supination amounts to only 8-21%. Refixation may be indicated for cosmetic reasons and offers a small but evident improvement of flexion and supination power. Deformity of the slipped muscle can be corrected effectively. Residual complaints after conservative treatment often result from associated subacromial problems. Distal ruptures. Ruptures of the distal tendon should be treated operatively. The loss of power after conservative treatment is evident (30-40% for flexion, >50% for supination). Extra-anatomical tenodesis to the brachialis muscle or anatomical fixation to the radial tuberosity can be applied. Flexion power and cosmesis can be addressed by both techniques. If supination strength is to be restored, the tendon has to be fixed anatomically. Preparation of the tuberosity bears the risk of heterotopic ossification or nerve damage. Mini-open techniques, using only a limited anterior approach, may decrease risks.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.