Surgical Treatment of Distal Triceps Ruptures

Author(s): Van Reit RP, Morrey BF, Ho E, O’Driscoll SW

Source: J of Bone and Joint Surgery 85A: 1961-1967, 2003.

Summary:

This is a retrospective review of 22 distal triceps tendon ruptures.  An eccentric triceps contraction during a fall on an outstretched hand was the most common mechanism of injury.  Eight patients were diagnosed within 3 weeks of the injury and underwent a successful primary repair with either a Bunnell or Krakow-type suture.  Five patients presented 3 weeks after the injury and 10 patients had a delayed diagnosis.  A primary repair was still possible in 6 of these 15 patients.  The remaining 9 patients underwent a variety of reconstructive procedures including 6 with autogenous tissue transfer (including palmaris longus, plantaris semitendinosis latissimus dorsi and anconeus).  Three underwent reconstruction with synthetic tissue.  Postopeperative immobilization included 2-6 weeks in 13 patients and 7 patients were placed initially in a dynamic extension splint.  Three patients sustained a re-rupture following primary repair.  One patient developed ulnar neuropathy and another experienced prominent hardware.  Elbow range of motion included a 10 degree loss of extension and average flexion of 136 degrees.  Peak isokenetic strength averaged 82% of that of the uninvolved extremity after more than one-year follow-up and peak strength averaged 92% of the untreated extremity after primary suture repair compared with 66% after triceps reconstruction.  Subjectively, all 13 patients with acute repair and all 7 patients with a reconstruction were satisfied with the result of the surgery. Two patients had limited range of motion due to post- traumatic arthritis.  Radiographic findings are often minimal with only 4 patients in the series exhibiting radiographic findings of small flakes of loose bone.

This article underscores the need for early diagnosis and intervention to optimize the outcome for the treatment of distal triceps tendon ruptures.  Although this is a rare injury, all patients treated within 3 weeks were able to be repaired primarily.  This was the case in only 6 of 15 patients with a delayed presentation.  The initial diagnosis may be difficult to make secondary to swelling, pain, limitation of motion and continuity of the lateral and medial fascia with central tendon disruption .  Serial examinations are paramount to make the diagnosis and an MRI or ultrasound may be confirmatory.

 

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J of Bone and Joint Surgery