Chronic Triceps Tendon Rupture Treated With Achilles Tendon Allograft
Lee Hunter MD, MBA (Hunter Medical Founder and Chief Medical Officer)
November 2016
35 YO RHD Male With 3-Month-Old Superficial Head Triceps Tendon Rupture
Supine positioning is fast, efficient, and optimizes patient airway access for the Anesthesiologist. Traditionally, however, it has been difficult to control static elbow extension to appropriately tension tricep repairs with the patient supine. Assistants can fatigue, and sterile bolsters or props can shift, frustrating the surgeon, compromising the repair and thus the outcome. The surgery can be performed with the patient lateral, or even prone. These methods, however, cost precious operating room time, offer suboptimal or challenging airway access for the anesthesiologist, and require extra assistants to hold the arm and manipulate it throughout the procedure. This case represents how tricep tendon repairs can now be performed easily, faster, and efficiently, with supine positioning using the ElbowLOC®Arm Positioning System.
The Case
The patient presented to my office with a three-month history of weakness and activity-related soreness in his left arm after falling off a deck at his home. The physical exam was consistent with a triceps tendon injury, and his MRI is below:
The procedure was performed using the ElbowLOC®in supine positioning mode, with one assistant. After identifying and protecting the radial nerve, Immobilized the stump of the superficial head of the triceps. Even with aggressive mobilization, I still had about a 2-inch gap between the native tendon and the olecranon. An Achilles tendon allograft was woven into the native triceps proximal in a Pulvertaft type weave. Distally, I ran double Krakow type sutures through three drill holes in the proximal ulna and tied the sutures over body bridges. These sutures were then doubled back through the allograft. The ElbowLOC®allows the surgeon to “dial-in” the desired elbow static extension with the patient supine. This enables surgeons now to repair these challenging triceps tendon tears with faster, more efficient, and safer patient positioning. This case is another great example of how the ElbowLOC®simplifies and accelerates procedural times for many elbow surgeries and makes surgery easier for the surgeon, patient, and staff!