Merten, Sheri M.

Background Different rehabilitation protocols have been used after repair of distal biceps ruptures. Purpose This study investigates the safety of immediate active range of motion protocol after modified 2-incision distal biceps tendon repair in acute ruptures. Study Design Case series; Level of evidence, 4. Materials and Methods Twenty-one patients with a minimum follow-up of 2 years were participants in this study. After repair, the upper extremities were placed in a sling for 1 to 2 days and then immediate active range of motion was started. For the first 6 weeks, the elbow was allowed activities of daily living as tolerated by the patient with a 1-lb weight-lifting restriction. Elbow range of motion, isometric and dynamic flexion, and supination strengths were recorded and Disabilities of the Arm, Shoulder and Hand (DASH) scores were obtained. Results Mean follow-up extension was 0° and mean follow-up flexion was 141° on the operated side, with supination of 74° and pronation of 75°. The mean DASH score for 21 patients was 3.6 ± 3.6 (range, 0-11.4). The mean follow-up isometric flexion strength was found to be 5% (P = .411), and the power (dynamic strength) of flexion was 12% greater on the operated side (P = .046). However, follow-up isometric supination strength was 9% less on the involved side than on the noninvolved side (P = .030), and the power of supination was 11% less on the operated side (P = .007). There were no tendon reruptures at follow-up, determined by physical examination. Conclusion A modified 2-incision distal biceps repair allows a safe immediate active range of motion protocol with early return of nearly full range of motion and strength, without any clinically significant disability.

Purpose Little information exists regarding arthroscopic treatment of coronoid fractures; this study reports outcomes in a series of patients. Methods Forty‐one coronoid fractures were identified by retrospective chart review; 7 were treated arthroscopically; 6 with >12 months of available follow‐up. Regan–Morrey fracture types were II (n = 4) and III (n = 3). The age of the patients averaged 37 years; the mechanism of injury was a fall in 6 patients and a motocross accident in 1 patient. Fracture fixation included: plate‐and‐screws following arthroscopic reduction (1); screws (2) and threaded Steinmann pins (2); 2 fractures were debrided. Three patients had immediate (2) or delayed (1) lateral ulnar collateral ligament repair. Results Follow‐up averaged 31.8 months. The range of motion averaged 9° to 133° in flexion–extension and 87°/79° in prono‐supination. Mayo Elbow Performance scores were 100 in 5 of 6 patients and unavailable in 1 patient. Complications included asymptomatic heterotopic ossification (1) and delayed ulnar neuropathy (1). Conclusions In our series of coronoid fractures treated with arthroscopic means, all patients had a functional, pain‐free result. All patients returned to preoperative avocations and occupations. Level of Evidence Level IV, therapeutic case series.

First carpometacarpal joint arthritis is a common condition encountered by hand surgeons. Traditionally, surgical approaches have included arthrodesis, trapeziectomy or reconstructive arthroplasty techniques. Previously, we described a technique for arthroscopic debridement and interposition arthroplasty of the first carpometacarpal joint. Patients with Eaton stages II and III symptomatic first carpometacarpal joint arthritis recalcitrant to >6 months of non-operative therapy underwent arthroscopic debridement of the first carpometacarpal joint with interposition of an acellular dermal matrix allograft (GRAFTJACKET™). In this paper, we describe outcomes following this procedure. Postoperatively, all patients reported symptomatic relief and 94% stated that they were partially, or completely, satisfied. More than 70% of patients reported no to mild difficulty in performing activities of daily living (average grip strength = 18.5 kg, pinch strength = 3.9 kg). Complications were minimal. Outcomes from this study compare favourably to those of other series, demonstrating that this technique is a viable option for treatment of Eaton stages II and III first carpometacarpal arthritis.