Surgical Treatment of Distal Triceps Ruptures

• Published in: Journal of bone and joint surgery. American volume 2003-10, Vol.85 (10), p.1961-1967
• Main Authors: van Riet, Roger P, Morrey, Bernard F, Ho, Emmy, OʼDriscoll, Shawn W
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arm Injuries - diagnosis; Arm Injuries - physiopathology; Arm Injuries - surgery; Biological and medical sciences; Biomechanical Phenomena; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Orthopedic surgery; Recovery of Function - physiology; Retrospective Studies; Rupture - diagnosis; Rupture - physiopathology; Rupture - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tendon Injuries - diagnosis; Tendon Injuries - physiopathology; Tendon Injuries - surgery; Time Factors; Treatment Outcome
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/00004623-200310000-00015

BackgroundDistal triceps tendon ruptures occur rarely, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of treatment of these injuries. The goal of this report was to present our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon ruptures in twenty-two patients. None of the ruptures followed joint replacement.MethodsTwenty-three procedures were performed in twenty-two patients with an average age of forty-seven years. The average duration of follow-up was ninety-three months (range, seven to 264 months). Data were obtained by a retrospective review of records and radiographs before and after surgery. Also, thirteen patients returned for follow-up and were examined clinically. Six additional patients responded to a telephone questionnaire. One patient was lost to follow-up, and two had died. Formal biomechanical evaluation of isokinetic strength and isokinetic work was performed in eight patients, at an average of eighty-eight months after surgery. Isokinetic strength data were available from the charts of two additional patients.ResultsTen of the triceps tendon ruptures were initially misdiagnosed. At the time of diagnosis, triceps weakness with a decreased active range of motion was found in most patients, and a palpable defect in the tendon was noted after sixteen ruptures. Operative findings revealed a complete tendon rupture in eight cases and partial injuries in fifteen. Fourteen primary repairs and nine reconstructions of various types were performed. Three of the primary repairs were followed by rerupture. At the time of follow-up, the range of elbow motion averaged 10° to 136°. All but two elbows had a functional range of motion; however, the lack of a functional range in the two elbows was probably due to posttraumatic arthritis and not to the triceps tendon rupture. Triceps strength was noted to be 4/5 or 5/5 on manual testing in all examined subjects. Isokinetic testing of ten patients showed that peak strength was, on the average, 82% of that of the untreated extremity. Testing showed the average endurance of the involved extremity to be 99% of that of the uninvolved arm. The results after repair and reconstruction were comparable, but the patientsʼ recovery was slower after reconstruction.ConclusionsThe diagnosis of distal triceps tendon rupture is often missed when the injury is acute