"Triple-Fix" Arthroscopic Biceps Tenodesis: Indications and Technique.

Pathology of the long head of the bicep tendon is a common cause of anterior shoulder pain and frequently is treated surgically using either tenodesis or tenotomy. Tenodesis often is the preferred technique for younger, more active patients and laborers, especially when cosmesis and preservation of function are clinical priorities. However, the security of the tenodesis varies with fixation methods and techniques, and failure of the tenodesis can have both cosmetic and symptomatic consequences. Traditional arthroscopic tenodesis also can be technically challenging, as it usually requires extra-articular identification of the bicep tendon within the bicipital groove. The arthroscopic surgical technique described is an approach that has been routinely employed by the senior author for approximately 8 years that allows for accurate and reproducible exposure of the biceps tendon within the bicipital groove along with secure, anatomic tenodesis of the long head of the bicep tendon.

Rates of neurovascular injury, compartment syndrome, and early infection in operatively treated civilian ballistic forearm fractures.

PURPOSE: The purpose of this study is to evaluate the incidence of neurovascular injuries, compartment syndrome, early postoperative infection as well as the injury factors predictive of neurovascular injury following ballistic fractures of the radius and ulna. METHODS: A retrospective review was performed to identify all ballistic fractures of the radius and ulna in skeletally mature patients over a 5-year period at a single level-1 trauma center. Chart and radiographic review was performed to identify patient and injury demographics, associated neurologic or vascular injuries, and fracture characteristics. Fracture location was measured on computerized imaging software and fractures were grouped into bone(s) segments involved. Proximal, mid-diaphyseal, and distal locations were used for statistical analysis. RESULTS: Fifty-six extremities in fifty-five patients were identified (mean age 32 years; male to female ratio 9:1). Overall incidence of neurologic injury was 50%, arterial injury 32%, and compartment syndrome 7.1%. Presence of a proximal third forearm fracture was associated with an increased risk for neurologic injury (p < 0.01), with an odds ratio of 5.7 (95% confidence interval, 1.7-18.4). Furthermore, all high velocity/energy ballistic injuries had associated neurologic injuries (p = 0.02). CONCLUSION: Ballistic forearm fractures result in high rates of neurovascular injury. Fractures caused by high velocity/energy firearms have extremely high rates of neurologic injury when compared with low velocity ballistic injuries. Ballistic fractures involving the proximal third of the radius or ulna are five times more likely to be associated with neurologic injury after a ballistic injury and should be assessed carefully on initial evaluation.