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Änderung der Bohrrichtung am proximalen Radius zur Platzierung von EndoButton bei der Refixation der distalen Bizepssehne führt zur Schonung des N. radialis − Bericht über 37 Fälle

Change of drilling direction for placement of EndoButton for distal biceps refixation can protect the posterior interosseous nerve-report of 37 cases

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, zu untersuchen, ob durch Modifikation unserer OP-Technik bei höherer Fallzahl pro Operateur eine Reduktion der sowohl von uns als auch von anderen Autoren publizierten hohen Komplikationsrate nach Refixation der distalen Bizepssehne in EndoButton-Technik zu erzielen ist.

Methoden

Die funktionellen Ergebnisse und die Komplikationsrate von 27 durch 8 Operateure versorgten Patienten (Gruppe 1) wurden mit den Ergebnissen von 10 durch 3 Operateure in modifizierter Technik (Hautschnitt, Bohrrichtung im Radius, Verwendung von Wundhaken) versorgten Patienten (Gruppe 2) retrospektiv verglichen.

Ergebnisse

Die funktionellen Ergebnisse [Mayo Elbow Performance Score; Disabilities of the Arm, Shoulder and Hand (DASH) Score; American Shoulder and Elbow Surgeons (ASES) Score; Beweglichkeit; Flexions- und Supinationskraft] waren 36,2 Monate (Gruppe 1) bzw. 14,5 Monate (Gruppe 2) nicht signifikant unterschiedlich. In Gruppe 1 wiesen bei einer Komplikationsrate von 33 % 9 Patienten 14 Komplikationen (u. a. 4 vorübergehende Läsionen des tiefen und 2 persistierende Läsionen des oberflächlichen Radialisastes) auf und in Gruppe 2 bei einer Komplikationsrate von 10 % ein Patient 2 Komplikationen.

Schlussfolgerung

Eine Reduktion der hohen Komplikationsrate nach Refixation der distalen Bizepssehne in EndoButton-Technik ist durch Kenntnis der anatomischen und OP-technischen Fallstricke möglich. Eine weitere Reduktion der Rate von Läsionen des motorischen Radialisastes ist möglicherweise durch unikortikales Bohren zu erzielen, wobei der EndoButton intramedullär zu liegen kommt.

Abstract

Background

The aim of the present study was to examine whether a reduction of the published high complication rate after distal biceps tendon repair with the cortical button technique is possible by modification of the operative technique and an increased number of operations per surgeon.

Methods

This study retrospectively compared the functional results and complication rates of 27 patients who had been operated on by 8 different surgeons (group 1) with the results of 10 patients who had been operated on using a modified technique (e.g. skin incision, direction of the drill through the radius and handling of retractors) by 3 different surgeons (group 2).

Results

The functional results, measured by the Mayo elbow performance score, the disabilities of arm, shoulder, hand (DASH) score and the American shoulder and elbow surgeons (ASES) score, range of motion, flexion and supination strength, showed no significant differences between group 1 (follow-up 36.2 months) and group 2 (follow-up 14.5 months). In group 1 (complication rate 33 %) 9 patients had 14 complications including 4 transient palsies of the deep and 2 persistent palsies of the superficial branch of the radial nerve, while in group 2 (complication rate 10 %) 1 patient had 2 different complications.

Conclusion

The high complication rate after distal biceps tendon repair using the EndoButton technique can be reduced by knowledge of the anatomy and of potential technical pitfalls. A further reduction of the rate of lesions of the posterior interosseous nerve may result from unicortical drilling with placement of the EndoButton within the medulla of the radius.

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Authors and Affiliations

  1. Abteilung für Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln Merheim, Universität Witten/Herdecke, Ostmerheimerstr. 200, 51109, Köln, Deutschland

    Marc Banerjee MD, Bertil Bouillon MD & Maurice Balke MD

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  1. Marc Banerjee MD
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  2. Bertil Bouillon MD
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  3. Maurice Balke MD
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Correspondence to Marc Banerjee MD.

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Banerjee, M., Bouillon, B. & Balke, M. Änderung der Bohrrichtung am proximalen Radius zur Platzierung von EndoButton bei der Refixation der distalen Bizepssehne führt zur Schonung des N. radialis − Bericht über 37 Fälle. Obere Extremität 9, 289–294 (2014). https://doi.org/10.1007/s11678-014-0253-5

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