Primary Repair of Traumatic Distal Biceps Ruptures in a Military Population: Clinical Outcomes of Single- Versus 2-Incision Technique

Reinserção da ruptura distal do bíceps braquial mediante incisão única com uso de âncoras

“…Regarding the recovery of the operated limb strength, the results were similar to those reported in other studies with different techniques, ranging from 80% to 95% for elbow supination, and from 90% to 95% for elbow flexion. 2,6,8,[12][13][14]23 The postoperative development of heterotopic ossification was not observed in any of our patients, even though the group did not adopt a routine use of non-hormonal anti-inflammatory drugs, as this prophylaxis may increase the risk of gastrointestinal bleeding. One case of anchor release occurred during the recovery process, but it did not negatively affect objective tests results, representing a 6.6% complication rate, similar to that of studies published in the literature.…”

“…Our case series is consistent with worldwide findings, in which DBBT rupture is more common in the dominant limb of men between the fourth and fifth decades of life. 3,6 The literature describes several surgical techniques for the treatment of DBBT injury; the first of them is performed 2,4,6,8,[12][13][14][15][16][17] We chose to use a 4-cm forearm single anterior approach over the anterior radius tuberosity because it minimizes the dissection of soft tissue during the repair, as it does not cross syndesmosis, and provides direct access to the radial attachment site of the DBBT, enabling a more anatomical ulnar reinsertion and sparing the tuberosity. 8,15,22,23 In addition, this technique provides good esthetic results after healing (►Figure 6).…”

“…In addition, clinical studies comparing anchors with other implants have shown good outcomes with the use of anchors. 3,8,13,15,22,24 In Brazil, anchors have been widely used in other procedures, such shoulder surgeries, as they are provided by the Brazilian Unified Health System (Sistema Único de Saúde, SUS, in Portuguese), in addition to interference screws. On the other hand, metallic buttons are not on the official list of implants offered by the SUS (Management System for the Table of Procedures, Drugs and Orthotics, Prosthetics and Special Materials, Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Órteses, Próteses e Materiais Especiais, SIGTAP, in Portuguese).…”

“…[7][8][9][10][11] As such, surgical repair with anatomical reinsertion of the DBBT in the radial tuberosity is indicated for athletes, active patients with high demand, and those who do not accept permanent functional deficits or esthetic deformity. [11][12][13][14] There are several surgical techniques for the repair of DBBT rupture; the first of them is through a single anterior incision across the elbow. Other techniques were introduced later, such as the double anterior incision and double mini incision, including an anterior and a posterolateral incision.…”

“…The literature reports radial artery injury, median nerve injury, posterior interosseous nerve injury and proximal radioulnar synostosis as complications resulting from these techniques. 2,4,6,8,[12][13][14][15][16][17] In-depth knowledge of local anatomy minimizes postoperative complications. As a result, the transverse anterior approach at the radial tuberosity region is more anatomical and respects regional force lines; in addition, it does not cross the anterior elbow crease, avoiding cicatricial retractions.…”