Background: The bicipital aponeurosis (BA) can often be torn concomitantly with a distal biceps tendon (DBT) rupture. Its repair, although recommended by some, has not commonly been addressed during the surgical management of DBT ruptures, and to date, surgical repair of the BA with DBT repair has not been evaluated clinically. Purpose: To utilize subjective and objective outcome measures to examine the safety and efficacy of 2-incision DBT repair with and without repair of the BA in patients with a DBT rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Demographic and surgical data were reviewed retrospectively. Patients returned to the clinic to complete subjective outcome measures and objective measurements of range of motion, strength, and biceps contour. All patients were evaluated at least 1 year after surgical treatment. Results: Data from 24 male patients with a DBT rupture were used for the analysis; 13 (54%) underwent concomitant DBT and BA repair, and 11 (46%) underwent isolated DBT repair. There were no complications at 1 year in either group. The DBT + BA repair group returned to recreational activities faster (77% within 6 months and 100% within 1 year) than the isolated DBT repair group (36% within 6 months, 91% within 1 year, and 100% after more than 2 years) ( P = .05). There was a trend toward better Patient-Rated Elbow Evaluation pain scores in the DBT + BA repair group than in the isolated DBT repair group (1.2 vs 5.3, respectively; P = .18). A trend also emerged toward closer return to subjective preinjury strength (77% vs 44%, respectively; P = .14). No significant difference emerged in patient satisfaction with the biceps contour, subjective scores on functional activities and disability, or objective measurements of strength, contour, and range of motion. Conclusion: This pilot study suggests that repair of the BA in conjunction with DBT repair leads to a faster return to recreational activities compared with isolated DBT repair. Also noted was a trend toward subjectively improved pain and greater perceived strength, after DBT + BA repair, although this was not statistically significant. Further investigation with a larger population is required to better elucidate these potential differences.

Middle third clavicle fractures are common injuries that need surgical fixation in a certain subset of patients. The use of pre-contoured clavicle plates facilitates intra-operative fixation and can reduce soft tissue irritation and hardware removal rates. Lag screw fixation is a well-established technique for the treatment of oblique fractures. Empirical application of this method in clavicle fracture fixation and clavicle non-union treatment has been reported previously. A recent biomechanical study supports the use of a lag screw technique in clavicle fracture fixation when possible. We report a 46 year old patient with a mid-shaft right clavicle fracture who was treated with this technique, which resulted in an excellent clinical outcome.