Z Orthop Unfall 2024; 162(01): 79-84
DOI: 10.1055/a-1865-0033
Case Report

Distal Triceps Rupture with an Injury of the Medial Ulnar Collateral Ligament: a Result of a Fall Onto an Outstretched Arm - a Case Series

Sturz auf den ausgestreckten Arm - Trizepssehnenruptur mit Läsion des medialen Kollateralbandes
Nadine Ott
1   Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany (Ringgold ID: RIN61059)
,
Michael Hackl
1   Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany (Ringgold ID: RIN61059)
,
Michiel Van Parys
2   Shoulder and Elbow, Ghent University, Ghent, Belgium (Ringgold ID: RIN26656)
,
Tim Leschinger
1   Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany (Ringgold ID: RIN61059)
,
Kilian Wegmann
1   Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany (Ringgold ID: RIN61059)
3   -, Orthopädische Chirurgie München (OCM), München, Germany
,
Lars Peter Müller
1   Department of Orthopedic and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Köln, Germany (Ringgold ID: RIN61059)
› Author Affiliations

Abstract

Traumatic triceps tendon ruptures are rare and known to result in substantial disability unless appropriate surgical treatment is performed. A traumatic rupture can occur due to a fall onto the outstretched hand. Tearing of the triceps tendon results in a valgus load onto the elbow, which can lead to injuries to the radial head/neck and/or the ulnar collateral ligament. Hence, attention must be paid to associated pathologies after diagnosis of rupture to the distal triceps tendon. Our surgical procedure in these cases includes diagnostic arthroscopy to detect concomitant injuries. In the following, we present three cases where we performed an open suture bridge repair of the triceps tendon followed by suture repair of the ulnar collateral ligament. All patients recovered well and reported no elbow pain or limited range of motion. The ASES and Mayo Elbow Performance scores were 100 at the 1-year follow-up.

Zusammenfassung

Traumatische distale Trizepssehnenverletzungen sind seltene Verletzungen. Nichtsdestotrotz ist die korrekte Therapie entscheidend für die Funktion des Armes. Der Sturz auf den ausgestreckten Arm kann die Ursache sein. Die Ruptur der Sehne im Unfallmoment verändert die Krafteinwirkung, sodass Begleitverletzungen wie die Radiuskopffraktur oder der Riss des medialen, ulnaren Kollateralbandes nicht selten sind. Daher sind mögliche Begleitverletzungen bei einer distalen Trizepssehnenruptur dezidiert zu prüfen. Gemäß unserem Vorgehen kann neben der MRT-Diagnostik eine Arthroskopie hilfreich sein, um mögliche Begleitpathologie adäquat zu erfassen und zu adressieren. Im Folgenden werden drei Fälle vorgestellt, die operativ mittels Trizepssehnen-Naht sowie Refixation des medialen ulnaren Kollateralbandes versorgt wurden. Das 1-Jahres-Followup zeigte keine Bewegungseinschränkungen oder Instabilitäten, der ASES- und Mayo Elbow Score waren 100.



Publication History

Received: 30 November 2021

Accepted after revision: 21 May 2022

Article published online:
04 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Mair SD, Isbell WM, Gill TJ. et al. Triceps tendon ruptures in professional football players. Am J Sports Med 2004; 32: 431-434 DOI: 10.1177/0095399703258707. (PMID: 14977669)
  • 2 Yeh PC, Dodds SD, Smart LR. et al. Distal triceps rupture. J Am Acad Orthop Surg 2010; 18: 31-40 DOI: 10.5435/00124635-201001000-00005. (PMID: 20044490)
  • 3 Canbora K, Ozyurek S, Gumussuyu G. et al. Triceps tendon avulsion and associated injuries of the elbow. BMJ Case Rep 2013; 2013: bcr2013009460 DOI: 10.1136/bcr-2013-009460. (PMID: 23667221)
  • 4 Lee JH, Ahn KB, Kwon KR. et al. Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop Relat Res 2021; 479: 781-789 DOI: 10.1097/CORR.0000000000001550. (PMID: 33181575)
  • 5 Marinello PG, Peers S, Sraj S. et al. A treatment algorithm for the management of distal triceps ruptures. Tech Hand Up Extrem Surg 2015; 19: 73-80 DOI: 10.1097/BTH.0000000000000082. (PMID: 25955270)
  • 6 Levy M, Goldberg I, Meir I. Fracture of the head of the radius with a tear or avulsion of the triceps tendon. A new syndrome?. J Bone Joint Surg Br 1982; 64: 70-72 DOI: 10.1302/0301-620X.64B1.7068723. (PMID: 7068723)
  • 7 Tatebe M, Horii E, Nakamura R. Chronically ruptured triceps tendon with avulsion of the medial collateral ligament: a report of 2 cases. J Shoulder Elbow Surg 2007; 16: e5-e7
  • 8 Yoon MY, Koris MJ, Ortiz JA. et al. Triceps avulsion, radial head fracture, and medial collateral ligament rupture about the elbow: a report of 4 cases. J Shoulder Elbow Surg 2012; 21: e12-e17
  • 9 van Riet RP, Morrey BF, Ho E. et al. Surgical treatment of distal triceps ruptures. J Bone Joint Surg Am 2003; 85: 1961-1967 DOI: 10.2106/00004623-200310000-00015. (PMID: 14563805)
  • 10 Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop 1991; 265: 187-195 (PMID: 2009657)