Reconstruction of Posterior Interosseous Nerve Injury following Biceps Tendon Repair: Case Report and Cadaveric Study

Mokhtee, David; Brown, Justin M.; Mackinnon, Susan E.; Tung, Thomas H.

doi:10.1007/s11552-008-9135-x

Cited by 13 publications

(9 citation statements)

References 17 publications

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“…19 Our results collated the largest number of PIN injuries reported and did not demonstrate a significantly higher rate of PIN injury according to either surgical approach or fixation technique, although the trend was higher in the cortical button group, as in the study by Nigro et al 27 The results would suggest that an expectant approach for the first 3 months is possible after PIN injury regardless of technique or approach used. However, Mokhtee et al 25 reported 2 cases where the PIN had neuromas as a result of a suture entangling the nerve, which was managed with excision and grafting. Another study reported an incident of a cortical button deployed exactly onto the nerve, which needed revising the procedure.…”

Section: Discussionmentioning

confidence: 99%

Complications After Distal Biceps Tendon Repair: A Systematic Review

et al. 2020

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Background: Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. Purpose: To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications. Study Design: Systematic review. Methods: Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods. Results: Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate. Conclusion: This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent. Registration: CRD42017074066 (PROSPERO).

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Section: Discussionmentioning

confidence: 99%

Complications After Distal Biceps Tendon Repair: A Systematic Review

et al. 2020

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“…The vast majority of patients will return to function; however, complications may occur. Perhaps the most dreaded of these is injury to the posterior interosseous nerve, which can take the form of limited, self-resolving neuropraxia or have devastating implications for function of the hand, requiring tendon transfers or nerve grafting procedures [ 3 ]. Though PIN injury can be recognized by classic symptomatology and is treated successfully with conservative therapy, MRI imaging is occasionally necessary to confirm the findings and to elucidate the cause of nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Imaging of Posterior Interosseous Neuropathy following Distal Biceps Repair: A Report of 3 Cases

Fitzpatrick

Petchprapa

Rybak

2015

Case Reports in Radiology

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Three cases of PIN palsy following biceps repair are presented with clinical and imaging correlation. The imaging findings in these cases will be discussed and the orthopedic literature, as regards possible surgical approaches and technical factors believed to predispose to or prevent this complication, will be reviewed. It is important for radiologists to serve as consultants in these uncommon but sometimes devastating complications, helping to quickly and accurately recognize the imaging findings corresponding to the clinical symptoms and aiding the surgeon in diagnosis and treatment by identifying the possible causes and sites of nerve compression.

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“…4,9 Injury to the PIN can still occur with the double-incision technique, possibly due to traction or aberrant retractor placement during the posterior exposure and attachment of the tendon to the tuberosity. 14 Position of the forearm during biceps repair is also an important factor in nerve injury. Although it is commonly reported that positioning the forearm in pronation protects the PIN during biceps repair through the posterolateral approach, a recent report has suggested that the pronated position may lead to increased pressure on the nerve as it travels through the supinator.…”

Section: Discussionmentioning

confidence: 99%