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Arvin Eslami Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Mohammadreza Chehrassan Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Shaya Alimoghadam Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Karim Pisoudeh Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Amir Kasaeian Digestive Oncology Research Center, Digestive Diseases Research Institute; Research Center for Chronic Inflammatory Diseases; Clinical Research Development Unit, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

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Omid Elahifar Bone and Joint reconstruction research center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran
Firoozgar Hospital, Bone and Joint reconstruction research center, Iran University of Medical Sciences, Tehran, Iran
Department of Orthopedic, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

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Purpose

  • This systematic review aims to investigate the management and outcomes of pelvic ring fractures (PRFs) during pregnancy, emphasizing maternal and fetal mortality rates, mechanisms of injury, and treatment modalities.

Methods

  • Following PRISMA guidelines, we conducted a comprehensive search of databases from 2000 to 2023. This search identified 15 relevant studies involving a total of 33 patients. Data extraction included demographics, fracture types, treatment methods, and outcomes. Risk of bias was assessed using the JBI criteria.

Results

  • Maternal mortality stood at 9.1%, with fetal mortality at 42.4%. Maternal factors impacting mortality included head trauma and hemodynamic instability. Fetal mortality correlated with mechanisms like motor vehicle accidents and maternal vital signs. Surgical and conservative treatments were applied, with a majority of pelvic surgeries performed before delivery. External fixators proved effective in fracture stabilization.

Conclusion

  • Pelvic ring fractures during pregnancy present significant risks to maternal and fetal health. Early stabilization and vigilant monitoring of maternal vital signs are crucial. Vaginal bleeding/discharge serves as a critical fetal risk indicator. The choice between surgical and conservative treatment minimally influenced outcomes. Multidisciplinary collaboration and tailored interventions are essential in managing these complex cases.

Open access
Luca Pacchiarini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Lorenzo Massimo Oldrini Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Pietro Feltri Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland

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Stefano Lucchina Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Surgical Department, Hand Surgery Unit EOC, Locarno’s Regional Hospital, Locarno, Switzerland
Locarno Hand Center, Locarno, Switzerland

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Giuseppe Filardo Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Christian Candrian Service of Orthopaedics and Traumatology, Department of Surgery, EOC, Lugano, Switzerland
Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland

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Purpose

  • Distal radius fractures (DRFs) represent up to 18% of all fractures in the elderly population, yet studies on the rate of complications following surgery are lacking in the literature. This systematic review aimed to quantify the rate of complications and reinterventions in patients treated with volar plate for distal radius fractures, and analyze if there was any predisposing factor.

Methods

  • A comprehensive literature search was performed on three databases up to January 2023, following PRISMA guidelines. Studies describing volar plate complications and hardware removal were included. A systematic review was performed on complications and rate of reintervention. Assessment of risk of bias and quality of evidence was performed with the ‘Down and Black’s Checklist for measuring quality’.

Results

  • About112 studies including 17 288 patients were included. The number of complications was 2434 in 2335 patients; the most frequent was carpal tunnel syndrome (CTS), representing 14.3% of all complications. About 104 studies reported the number of reinterventions, being 1880 with a reintervention rate of 8.5%. About 84 studies reported the reason of reintervention; the most common were patient’s will (3.0%), pain (1.1%), CTS (1.2%), and device failure (1.1%).

Conclusion

  • The complication rate after DRFs is 13.5%, with the main complication being CTS (14.3%), followed by pain and tendinopathy. The reintervention rate is 8.5%, mainly due to the patient’s willingness, and all these patients had plate removal. Correct positioning of the plate and correct information to the patient before surgery can reduce the number of hardware removal, thereby reducing costs and the risk of complications associated with VLP for distal radius fractures.

Open access
Guo-xu Zhang Guangzhou University of Chinese Medicine, Guangzhou, China

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Ji Li Guangzhou University of Chinese Medicine, Guangzhou, China

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Qi-jun Xie Guangzhou University of Chinese Medicine, Guangzhou, China

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Mei-ren Zhang Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China

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Kui Zhao Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China

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Hai-yun Chen Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China

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Objective

  • Through meta-analysis, this study aims to comprehensively evaluate the efficacy of single-plating and double-plating in the treatment of comminuted fractures of the distal femur.

Methods

  • Computer searches of PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, and Wanfang digital journals were performed, and the timeframe for the searches was from the establishment of each database to July 2023 for each of the databases. Meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Library, and the review process was registered in the PROSPERO database.

Results

  • A total of ten studies were included for statistical analysis. One randomised controlled study and nine retrospective cohort studies with a total of 563 patients were included. The double-plate group was superior to the single-plate group in terms of knee mobility at 6 months postoperatively, overall postoperative complications, and the rate of healing of knee deformity. However, it increased the operation time and intraoperative bleeding, and the difference between the two groups was statistically significant (P < 0.05). There was no significant difference between the two groups in terms of excellent knee function rate, fracture healing time, plate fracture, postoperative infection, delayed fracture healing, and non-union (P ≥ 0.05).

Conclusion

  • Double plate fixation for comminuted fractures of the distal femur can improve knee mobility at 6 months postoperatively, reduce overall postoperative complications, and decrease the incidence of malunion healing. However, it increases operative time and bleeding. Randomised studies are needed to provide strong evidence in the future.

Open access
Juan Ramón Cano Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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José Manuel Bogallo Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Alicia Ramirez Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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Enrique Guerado Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Malaga, Spain

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  • The diagnosis of a traumatic unstable pelvis in a stable patient is a temporary concept depending on when we see the patient, as all patients presenting with hemorrhagic shock have hemodynamic stability until they become unstable. As a rule, the more unstable the pelvic fracture is, the higher the risk of bleeding and hemodynamic instability it has. Therefore, in unstable pelvic fractures, hemodynamic stability should be a diagnosis by exclusion.

  • For bleeding detection in stable patients, an immediate one-stage contrast-enhanced CT scan is the appropriate diagnosis test; however, since CT scan radiation is always an issue, X-rays should be considered in those cases of hemodynamically stable patients in whom there is a reasonable suspicion that no unsafe bleeding is going on. Pelvic fracture classification is essential as usually there is an association between the injury mechanism, the fracture displacement, and the hemodynamic stability. Anteroposterior and, particularly, vertical traumatisms have much more proclivity to provoke major pelvic displacement and bleeding.

  • The use of a pelvic binder, as early as possible including pre-hospital management, should be standard in high-impact blunt trauma patients independently of the trauma mechanisms. External fixation is the preferred method of stabilization in case of open fractures, and, in closed ones, when the schedule for definite osteosynthesis prolongs because of the patient’s general condition. If possible, immediate percutaneous sacroiliac screw insertion for unstable pelvic fractures produce excellent results even in open fractures.

Open access
Andreas Frodl Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Johannes Hauss Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Andreas Fuchs Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Markus Siegel Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Hagen Schmal Department of Orthopedic Surgery, University Hospital Odense, Odense, Denmark

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Jan Kühle Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany

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Purpose

  • The fixation method of distal, extra-articular femur fractures is a controversially discussed. To ensure better stability itself, earlier mobilization and to prevent blood loss – all these are justifications for addressing the femur via reamed intramedullary nailing (RIMN). Anatomical reposition of multifragmentary fractures followed by increased risks of non-union are compelling reasons against it. The purpose of this study was to systematically review the literature for rates of non-union and wound infection, as well as blood loss and time of surgery.

Methods

  • According to the PRISMA guidelines we conducted this systematic review by searching the Cochrane, PubMed, Ovid, MedLine, and Embase databases. Inclusion criteria were the modified Coleman methodology score (mCMS) >60, age >18 years, and extra-articular fractures of the distal femur. Biomechanical and animal studies were excluded. By referring to title and abstract relevant articles were reviewed independently. In the consecutive meta-analysis, we compared 9 studies and 639 patients.

Results

  • There is no statistically significant difference comparing superficial wound infections when RIMN was performed (OR = 0.50; 95% CI: 0.18 – 1.42; P = 0.19) as well as in deep wound infections (OR = 0.74; 95% CI: 0.19–2.81; P = 0.62). However, these results were not significant. We also calculated for potential differences in the rate of non-unions depending on the surgical treatment applied. Data of 556 patients revealed an overall number of 43 non-unions. There was no significant difference in rate of non-unions between both groups (OR = 0.97; 95% CI: 0.51–1.85; P = 0.92).

Conclusion

  • No statistical difference was found in our study among RIMN and plate fixation in the treatment of distal femoral fractures with regard to the incidence of non-union and wound infections. Therefore, the indication for RIMN or plating should be made individually and based on the surgeon’s experience.

Open access
Markus Walther Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Justus Maximilian University Wuerzburg, König-Ludwig-Haus, Brettreichstraße, Würzburg, Germany
Paracelsus Medizinische Privatuniversität, Strubergasse, Salzburg, Austria
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany

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Oliver Gottschalk Schön Klinik München Harlaching – FIFA Medical Centre of Excellence, Harlachinger Straße, Munich, Germany
Ludwig Maximilian University Munich, Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Zentrum München (MUM), Marchionostraße, Munich, Germany
Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany

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Matthias Aurich Working Group Clinical Tissue Regeneration of the German Society of Orthopaedics and Traumatology (DGOU), Berlin, Germany
Martin-Luther-University Halle-Wittenberg, Universitätsklinikum Halle (Saale), DOUW - Abteilung für Unfall- und Wiederherstellungschirurgie, Ernst-Grube-Straße, Halle, Germany
BG-Klinikum Bergmannstrost Halle, Halle, Saale, Germany

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  • The working group ‘Clinical Tissue Regeneration’ of the German Society of Orthopedics and Traumatology (DGOU) issues this paper with updating its guidelines.

  • Literature was analyzed regarding different topics relevant to osteochondral lesions of the talus (OLT) treatment. This process concluded with a statement for each topic reflecting the best scientific evidence available with a grade of recommendation. All group members rated the statements to identify possible gaps between literature and current clinical practice.

  • Fixation of a vital bony fragment should be considered in large fragments. In children with open physis, retrograde drilling seems to work better than in adults, but even there, the revision rate reaches 50%. The literature supports debridement with bone marrow stimulation (BMS) in lesions smaller than 1.0 cm² without bony defect. The additional use of a scaffold can be recommended in lesions larger than 1.0 cm². For other scaffolds besides AMIC®/Chondro-Gide®, there is only limited evidence. Systematic reviews report good to excellent clinical results in 87% of the patients after osteochondral transplantation (OCT), but donor site morbidity is of concern, reaching 16.9%. There is no evidence of any additional benefit from autologous chondrocyte implantation (ACI). Minced cartilage lacks any supporting data. Metallic resurfacing of OLT can only be recommended as a second-line treatment. A medial malleolar osteotomy has a minor effect on the clinical outcome compared to the many other factors influencing the clinical result.

Open access
Marc Saab CHU Lille, Orthopaedic and Traumatology Department, Hôpital Roger Salengro, Lille, France
University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

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Cédric Zobrist University of Lille, CNRS, INRAE, Centrale Lille, UMR 8207 – UMET – Unité Matériaux et Transformations, Lille, France

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Nicolas Blanchemain University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

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Bernard Martel University of Lille, CNRS, INRAE, Centrale Lille, UMR 8207 – UMET – Unité Matériaux et Transformations, Lille, France

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Feng Chai University of Lille, INSERM, CHU Lille, U1008 – Advanced Drug Delivery Systems and Biomaterials, Lille, France

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Purpose

  • The aim of this study was to conduct a systematic literature review analyzing the results of in vivo rat femoral defect models using biomaterials for improving the induced membrane technique (IMT).

Methods

  • Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Web of Science databases were searched. Inclusion criteria were studies reporting results of the IMT in in vivo rat femoral critical-sized defect models using a biomaterial possibly combined with molecules. Methodologic quality was assessed with the Animal Research: Reporting In Vivo Experiments guidelines.

Results

  • Twenty studies met the inclusion criteria. Femoral stabilization with plate and screws was the most frequent. Histologic, biomechanical, and/or radiologic analyses were performed. In two-stage strategies, the PMMA spacer could be associated with bioactive molecules to enhance IM growth factor expression and improve bone formation. Modulating the roughness of spacers could increase IM thickness and accelerate its formation. In one-stage strategies, human tissue-derived membranes combined with bone grafting achieved bone formation comparable to a standard IMT. All calcium phosphate grafts seemed to require a functionalization with growth factors or bone marrow mononuclear cells to improve outcomes compared with non-functionalized grafts.

Conclusion

  • This systematic review described the main parameters of the in vivo rat femoral defect models using biomaterials to improve the induced membrane technique. Although the studies included had several methodological limitations that may limit the scope of these conclusions, one- and two-stage strategies reported promising results with biomaterials to improve the IMT.

Open access
Vanessa Morello Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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Axel Gamulin Division of Orthopaedic and Trauma Surgery, University Hospitals of Geneva, Geneva, Switzerland

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Introduction

  • Acute compartment syndrome (ACS) is an orthopedic emergency that may lead to devastating sequelae. Diagnosis may be difficult. The aim of this systematic review is to identify clinical and radiological risk factors for ACS occurrence in tibial fractures.

Methods

  • PubMed® database was searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Additional articles were found by a manual research of selected references and authors’ known articles.

Results

  • The identification process individualized 2758 via database and 30 via other methods. After screening and eligibility assessment, 29 articles were included. Age, gender, occupation, comorbidities, medications, habits, polytrauma, multiple injuries, mechanism, sports, site, open vs closed, contiguous lesion, classification, and pattern were found to be related to ACS occurrence.

Conclusions

  • Younger age and male gender are strong independent risk factors in tibial plateau and shaft fractures. High-energy fractures, polytrauma, more proximal fractures and fractures with contiguous skeletal lesions are aggravating risk factors; higher AO/OTA and Schatzker classification types, increased displacement of the tibia relative to the femur, and increased tibial joint surface width are associated risk factors in tibial plateau fractures; higher AO Foundation/Orthopaedic Trauma Association classification types and subgroups and more proximal fractures within the diaphysis are associated risk factors in tibial shaft fracture. Open fractures do not prevent ACS occurrence. Increased fracture length is the only factor suggesting a higher risk of ACS in tibial pilon fractures. The presence of each independent predictor may have a cumulative effect increasing the risk of ACS occurrence.

Open access
Mehnoor Khaliq Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Vasileios P Giannoudis Leeds Orthopaedic & Trauma Sciences, School of Medicine, University of Leeds, Leeds, England

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Jeya Palan Leeds Teaching Hospitals NHS Trust, Leeds, England

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Hemant G Pandit Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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Bernard H van Duren Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, England

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  • Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, ‘Doctor, when can I drive?’ Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varying degrees of sample size and markedly differing study designs.

  • This instructional review article provides a scoping overview of studies looking at return to driving after upper or lower extremity surgery in both trauma and elective settings and, where possible, to provide clinical recommendations for return to driving.

  • Medline, EMBASE, SCOPUS, and Web of Science databases were searched according to a defined search protocol to elicit eligible studies. Articles were included if they reviewed adult drivers who underwent upper or lower extremity orthopaedic procedures, were written in English, and offered recommendations about driving.

  • A total of 68 articles were included in the analysis, with 36 assessing the lower extremity and 37 reviewing the upper extremity. The evidence available from the studies reviewed was of poor methodological quality. There was a lack of adequately powered, high quality, randomised controlled trials (RCTs) with large sample sizes to assess safe return to driving for differing subset of injuries.

  • Many articles provide generic guidelines on return to driving when patients feel safe to perform an emergency stop procedure with adequate steering wheel control.

  • In future, RCTs should be performed to develop definitive return to driving protocols in patients undergoing upper and lower extremity procedures.

Open access
Markus Jaschke Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

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Krzysztof Rekawek Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

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Sebastian Sokolowski Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

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Lukasz Kolodziej Department of Orthopaedics, Traumatology and Oncology of the Musculoskeletal System, Pomeranian Medical University Szczecin, Poland

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  • Distal biceps tendon (DBT) is a relatively rare injury mainly occurring in middle-aged men while in eccentric biceps muscle contraction.

  • Clinical appearance with proximal avulsion of the muscle and specific clinical tests are most of the time sufficient for diagnosing DBT, but if needed ultrasonography and MRI, most often in FABS view, can be used to ensure diagnosis of DBT and partial DBT.

  • Surgical anatomical reinsertion has shown to be a successful method of treatment, although conservative treatment can be initiated in older patients.

  • Two different approaches are described in literature: single- and double-incision techniques with different fixation methods proving to have similarly good results.

  • Major complications of surgical intervention are posterior interosseous nerve palsy and symptomatic heterotropic ossification.

  • Overall outcome of surgical intervention has shown high subjective satisfaction with slight weakness in flexion and supination but mostly without loss in range of motion.

Open access