title: High complication rate following distal biceps refixation with cortical button.
abstract: OBJECTIVE
  There are several methods for the refixation of the distal biceps tendon which show a variable complication rate. The aim of the present study was to evaluate the clinical outcome and complication rate after distal biceps repair in cortical button technique.
  
  
  METHODS
  Clinical results, complications, strength of elbow flexion and supination and radiological evidence of heterotopic ossification in patients reporting persistent pain were evaluated in 27 male patients after an average of 36.1 month following distal biceps tendon repair in cortical button technique.
  
  
  RESULTS
  The mean Mayo elbow performance score was 95.9 (SD 11.9), the mean disabilities of the arm, shoulder and hand score was 1.9 (SD 4.9) and the mean American shoulder and elbow surgeons (ASES) score was 94.6 (SD 11.6). The mean flexion and supination strength of the involved side relative to the uninvolved side was 91.7 % (SD 12.6) and 87.8 % (SD 15.9). Nine patients had 14 different complications including four transient lesions of the posterior interosseous nerve, two persistent lesions of the superficial branch of the radial nerve, one symptomatic massive heterotopic ossification and one disengaged cortical button. Three patients had six revisions. Patients with complications had a significantly lower relative supination strength, Mayo elbow performance score, ASES score, pain on VAS (p < 0.05 each) and satisfaction (p = 0.005).
  
  
  CONCLUSIONS
  As described for other techniques there is a high complication rate of distal biceps tendon repair in cortical button technique which resulted in inferior functional results and satisfaction. Surgeons treating patients with distal biceps tendon rupture should know the specific complications and know how to avoid them.
  
  
  METHODS
  Case series with no comparison group, Level IV.
authors.affiliation: Department of Orthopedic and Trauma Surgery, Faculty of Health-School of Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, Ostmerheimerstr. 200, 51109, Cologne, Germany, marc.banerjee@gmx.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Banerjee
authors.forename: Sven
authors.initials: S
authors.lastname: Shafizadeh
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Thorsten
authors.initials: T
authors.lastname: Tjardes
authors.forename: Arasch
authors.initials: A
authors.lastname: Wafaisade
authors.forename: Maurice
authors.initials: M
authors.lastname: Balke
mesh_terms: D000328:Adult; D001132:Arm; D004551:Elbow Joint / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000453:epidemiology / Q000209:etiology; D059348:Peripheral Nerve Injuries / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011884:Radius / Q000601:surgery; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000502:physiology; D013708:Tendon Injuries / Q000601:surgery*; D053656:Tenodesis / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014955:Wrist Joint / Q000502:physiology