Functional outcome after repair of distal biceps tendon ruptures using the endobutton technique.

HYPOTHESIS: The purpose of this study is to report the functional outcome of the repair of a distal biceps tendon rupture by the use of the endobutton technique. We hypothesized that the endobutton provides excellent strength and clinical results after repair of distal biceps tendon rupture. MATERIALS AND METHODS: Twenty-six patients underwent repair of biceps tendon ruptures by use of an endobutton for fixation of the biceps tendon stump to the radial tuberosity. There were 20 men and three women. The mean age was 52 years (39-75). The dominant side was involved in 11 patients. A partial rupture of the biceps tendon was found in four patients. The average delay in diagnosis was 16 days, with four patients presenting at six weeks or more after trauma. RESULTS: At an average follow-up of 16 months (6-48), 23 of 26 patients were available for follow-up and were examined clinically, radiologically, and by isokinetic testing. The average postoperative Mayo Elbow Performance Score (MEPS) was 94 points. The average Visual Analogue Scale (VAS) for pain was 1.5. Patients regained an almost full range of motion. Average flexion strength recovery was 80% and corresponding recovery of supination strength was 91%. Two patients developed asymptomatic heterotopic ossification seen on standard radiographs. In three patients, the endobutton had apparently disengaged without important difference in functional outcome. In one case, the endobutton had to be removed. There were no neurological complications. CONCLUSION: This study shows that a distal biceps tendon can be safely reattached to the radius by using the endobutton technique, yielding excellent and reproducible results. LEVEL OF EVIDENCE: Level 4; Retrospective case series, no control group.

Pathophysiological mechanism of long-term noninvasive ventilation in stable hypercapnic patients with COPD using functional respiratory imaging.

INTRODUCTION: Patients with severe COPD often develop chronic hypercapnic respiratory failure. Their prognosis worsens and they are more likely to develop exacerbations. This has major influence on the health-related quality of life. Currently, there is no information about the success of long-term noninvasive ventilation (NIV) among patients who receive NIV in acute settings. Also, little is known about the pathophysiological mechanism of NIV. METHODS: Ten Global Initiative for Obstructive Lung Disease stage III and IV COPD patients with respiratory failure who were hospitalized following acute exacerbation were treated with NIV using a Synchrony BiPAP device for 6 months. Arterial blood gases and lung function parameters were measured. Low-dose computed tomography of the thorax was performed and used for segmentation. Further analyses provided lobe volume, airway volume, and airway resistance, giving an overall functional description of the separate airways and lobes. Ventilation perfusion (VQ) was calculated. Patient-reported outcomes were evaluated. RESULTS: PaCO2 significantly improved from 50.03 mmHg at baseline to 44.75 mmHg after 1 month and 43.37 mmHg after 6 months (P=0.006). Subjects showed improvement in the 6-minute walk tests (6MWTs) by an average of 51 m (from 332 m at baseline to 359 m at 1 month and 383 m at 6 months). Patients demonstrated improvement in self-reported anxiety (P=0.018). The improvement in image-based VQ was positively associated with the 6MWT and the anxiety domain of the Severe Respiratory Insufficiency Questionnaire. CONCLUSION: Though previous studies of long-term NIV have shown conflicting results, this study demonstrates that patients can benefit from long-term NIV treatment, resulting in improved VQ, gas exchange, and exercise tolerance.