Doble fijación para la rotura de bíceps distal: Descripción de la técnica y evaluación de resultados

Resumen

Introducción La ruptura del bíceps distal es una lesión infrecuente producida por la aplicación de una carga excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar nuestros resultados para la reinserción del bíceps distal mediante la técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única, con una casuística mayor a la presentada con anterioridad.

Material y Método Entre agosto de 2008 y agosto de 2015, se intervino 24 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 22 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y son el grupo de estudio de este artículo. Todos eran hombres, con una mediana de edad de 39,5 años (rango 22–59). Los pacientes fueron evaluados con el Cuestionario DASH y la valoración Subjetiva/Objetiva de Andrews y Carson, la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5).

Resultados El valor promedio del cuestionario DASH fue de 1,7 (0 - 31,6) y el de Andrews y Carson, de 197,5 (135–200), con 20 resultados excelentes, 1 bueno y 1 regular. Todos consiguieron una fuerza M5 para la flexión y la supinación de antebrazo. El tiempo promedio de seguimiento fue de 17,5 meses (10–38). En tres pacientes se registraron complicaciones, todos con una recuperación total.

Conclusión La técnica descrita demostró ser segura y eficaz, con resultados satisfactorios y baja tasa de complicaciones.

Nivel de Evidencia: IV. Serie de Casos.

Abstract

Purpose Distal biceps rupture is an unusual lesion produced after an eccentric load is applied to the bent elbow. The aim of this study is to analyze our results for the reinsertion of the distal biceps with a double fixation technique of cortical button and biotenodesis interference screw through a single anterior incision, with a larger number of cases cases than previously submitted.

Methods Between August 2008 and August 2015, 24 cases of distal biceps rupture, surgically treated through an anterior limited procedure. The last 22 consecutive cases were treated with double fixation using an extracortical button and biotenodesis screw and are the group tudied in this paper. All patients were males with a mean age of 39,5 years (range 22–59). Patients were evaluated using the DASH questionnaire and the subjective/ objective scoring system of Andrews and Carson, flexion and supination strengths were assessed with the British Medical Research Council scale, modified by Mackinnon and Dellon (M0-M5).

Results The mean DASH score was 1,7 (0–31,6), and the mean Andrews and Carson score was 197,5 (135–200), with 20 excellent, 1 good and 1 regular results. All patients achieved a M5 (level of) flexion and supination strenght of the forearm. The median follow-up period was 17,5 months (10–38). Complications were registered in three patients that recovered totally.

Conclusion The described technique proved to be both reliable and effective, giving satisfactory results with a low complication rate.

Level of Evidence IV. Case Series.

Palabras Clave

tendón del bíceps - rotura distal - técnica de doble fijación

Keywords

biceps tendón - distal ruptura - double fixation technique

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