Surgical Management of Distal Biceps Tendon Anatomical Reinsertion Complications: Iatrogenic Posterior Interosseous Nerve Palsy

Abstract

BackgroundAlthough iatrogenic posterior interosseous nerve (PIN) palsy is an uncommon complication of ruptured distal biceps brachii tendon surgical anatomical reinsertion, it is the most severe complication leading to functional limitation. The present study investigated possible types of PIN palsy as a postoperative complication of anatomical distal biceps tendon reinsertion, and aimed to clinically assess patients at 2 years after its surgical treatment.Material/MethodsThe studied sample comprised 7 male patients diagnosed with an iatrogenic PIN palsies after anatomical reinsertion of the distal biceps tendon, who were referred to the reference center for management of a peripheral nervous system injury. The nerve injury was intraoperatively evaluated. The clinical assessment used the Medical Research Council (MRC) System for motor recovery, and the Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) was performed before the surgical treatment of the PIN injuries and at 2 years postoperatively. In all studied cases, electromyography was performed preoperatively and postoperatively.ResultsThe comparison of the preoperative (x=1.43±0.53) and postoperative (x=4.71±0.49) results of the motor recovery of the PIN demonstrated a statistically significant improvement (p<0.001). Moreover, the results of functional assessments with the use of the Quick DASH questionnaire significantly improved (p<0.001) postoperatively (x=6.14±6.86) compared to the preoperative evaluations (x=54.29±12.05).ConclusionsThe PIN palsies as complications of the surgical anatomical reinsertion of ruptured distal biceps brachii resulted from mechanical nerve compression or direct intraoperative damage. The 2-year outcomes justified the clinical use of surgical management for iatrogenic PIN palsy.

Distal biceps repair through a single incision with the use of a knotless cortical button device: Mid-term results

“…15 In cases of PIN palsies that persist for more than 8-12 weeks, surgical exploration and potential neurolysis or revision of the implant position have been shown to yield satisfactory functional recovery. 16,17 To avoid perforating the dorsal radial cortex and thus prevent injury to the PIN, Siebenlist et al 6 reported on a series of 24 patients who underwent a repair with a pair of intramedullary cortical buttons. They used a hinged brace for 4 weeks and indomethacin to prevent the formation of HO, which differs from our practice as the literature supports early mobilisation with no increased risk of re-rupture.…”

“…15 In cases of PIN palsies that persist for more than 8–12 weeks, surgical exploration and potential neurolysis or revision of the implant position have been shown to yield satisfactory functional recovery. 16,17…”

Radial nerve compression: anatomical perspective and clinical consequences

“…The palsy may result from compression by a cortical button, a fibrotic hematoma, or direct pressure from the biceps brachii evoked by incorrect positioning of the forearm in the primary surgery. It was reported that the neuropathy also occurred as a result of a direct damage from a drill usage or a dissection along the proximal radius since during supination the nerve is typically located on the shaft of the radius opposite the bicipital tuberosity [ 64 , 65 ].…”

Distal Biceps Tendon Tears: Diagnosis and Treatment Algorithm

“…The LABCN is identified and protected as it exits between the biceps and the brachialis at the level of the elbow joint. The forearm is kept in a supinated position to protect the PIN; the rate of injury of the PIN has been reported to range from 1% to 5% 57 .…”