Chronic triceps tendon ruptures are rare but challenging to treat due to limited muscle mobilization and difficulty in accurately assessing tendon length. Proper tendon length restoration is essential for maintaining physiological muscle tension, as excessive tendon length may lead to weakness and extension lag with reduced functional stability during elbow extension, whereas insufficient length can restrict elbow flexion and alter joint kinematics. This study aimed to examine the length ratios of the distal triceps tendon and aponeurosis in relation to bony landmarks to provide an intraoperative reference for tendon length assessment in chronic defect situations. A total of 54 embalmed cadaveric upper limbs (male: 54%, female: 46%) were dissected. The following anatomical parameters were measured: the length of the distal triceps tendon from the olecranon (OL) tip to the musculotendinous junction, the lengths of the medial and lateral distal triceps aponeurosis, the length of the ulna (UL) and radius (RA), and the width of the OL and the distal humerus (intercondylar width). Pearson correlation coefficients were used to analyze relationships between tendon/aponeurosis lengths and bony landmarks. The mean length of the distal triceps tendon was 40 ± 15 mm, while the medial and lateral triceps aponeurosis measured 150 ± 17 mm and 115 ± 18 mm, respectively. Moderate correlations were observed between the distal triceps tendon length and both the width of the distal humerus (r = 0.42, P = .002) and the width of the OL (r = 0.36, P = .007). The lateral aponeurosis length showed strong correlations with UL length (r = 0.64, P < .001), RA length (r = 0.54, P < .001), and distal humerus width (r = 0.51, P < .001), while a moderate correlation was found with OL width (r = 0.41, P = .002). The medial aponeurosis length strongly correlated with the OL width (r = 0.54, P < .001) and UL length (r = 0.52, P < .001), and moderately with the RA length (r = 0.49, P < .001) and distal humerus intercondylar width (r = 0.44, P < .001). This study demonstrates that the lateral aponeurosis length correlates strongly with UL length, making it a particularly reliable reference for estimating the physiological triceps length in chronic defect situations. These findings provide an important anatomical basis for achieving precise triceps length restoration, which is essential for optimal clinical outcomes in reconstructive surgery.

Distal humerus fractures (DHFs) account for around 2% of all adult fractures. Since nonoperative strategies often lead to loss of motion and disability from prolonged immobilization, open reduction and internal fixation (ORIF) is a commonly employed first-line treatment for reconstructable DHFs and can yield satisfactory outcomes. Surgical recovery, however, is not without complications, with reported rates up to 30%. Prior studies often report ORIF in pooled or comparative settings, leaving a gap in isolated ORIF outcomes. Therefore, this study aims to analyze short-term postoperative complications following DHF ORIF. The American College of Surgeons National Surgery Quality Improvement Program database was queried using the Current Procedural Terminology code 24579. Patients with missing relevant variables were excluded. Postoperative outcomes included surgical site infection, wound dehiscence, return to the operating room (ROR), and any adverse event (AAE), among others. Continuous variables were reported as mean (standard deviation) and binary variables as number (%). Multivariate logistic regression with Bonferroni correction was used to model associated risk factors. Additionally, threshold analysis was applied to operative time for modeling complication risk. A total of 833 patients were identified (mean age = 53.9 ± 19.9; 71.8% female; 70.1% white; 68.3% outpatient; 50.1% American Society of Anesthesiologists class 2). Cohort comorbidities included smoking (18%) and diabetes (8.9%; 5.3% non-insulin dependent; 3.6% insulin-dependent). Overall, complication rates were low, with AAE occurring at 5.2% within 30 days. Surgical site infection, ROR, and wound dehiscence were all below 2%. Age (odds ratio [OR] = 1.03), operative time (OR = 1.01), hospital length of stay (OR = 1.2), and smoking (OR = 2.07) significantly increased AAE risk. A 97.1-minute significant operative time threshold was calculated, with complication rates of 7.8% and 1.4% above and below this cutoff, respectively (OR = 5.62). DHF ORIF demonstrates low short-term complication rates. However, factors such as increased age and smoking elicit reasonable operative concerns. Prolonging operative time was significantly associated with increased risks for AAE, the highest of which was observed beyond a 97-minute threshold for operative time. Targeted counseling is recommended, and future studies are warranted to further granularize outcomes.

Repair of medium to large rotator cuff tears (RCTs) presents ongoing challenges, as the procedure may result in tendon retear and inadequate healing. Partial superior capsular reconstruction (pSCR) using the long head of the biceps tendon (LHBT) has emerged as a biomechanically robust and biologically advantageous technique for augmenting rotator cuff repairs. This study aims to evaluate the clinical and structural outcomes of arthroscopic rotator cuff repair augmented with pSCR using the LHBT combined with distal tenotomy in patients with medium to large reparable RCTs at two years postoperatively. A retrospective review was conducted on patients who underwent arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy between January 2014 and June 2017. Surgical indications were reparable supraspinatus tears, with or without infraspinatus involvement, accompanied by tendon retraction, high-grade fatty infiltration, and an intact or less than 50% partial tear of the LHBT. Exclusion criteria included prior shoulder surgery, shoulder infection, irreparable subscapularis tear, or incomplete follow-up. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, and range of motion, while structural integrity was evaluated via ultrasonography at the 2-year follow-up. After excluding 10 patients, 45 patients (mean age: 67.2 ± 6.3 years) were included in the analysis. The VAS score improved significantly from 6.1 ± 1.3 to 1.7 ± 1.1, and the ASES score increased from 31.0 ± 7.9 to 77.2 ± 7.7 (both P < .001). Forward elevation improved from 95° to 156°, abduction from 78° to 142°, and external rotation from 33° to 50° (all P < .001). All patients met the minimal clinically important difference for both VAS and ASES scores. Ultrasonography at the 2-year follow-up demonstrated complete healing of the repair with the pSCR construct in 86.7% of patients, partial healing in 6.6%, and complete retear in 6.6%. No patients reported postoperative anterior shoulder pain. Subgroup analysis showed comparable outcomes between single-row repair with pSCR for medium-sized RCTs and double-row repair with pSCR for large-sized RCTs. Arthroscopic rotator cuff repair augmented with LHBT-based pSCR and distal tenotomy resulted in significant improvements in pain and range of motion at the 2-year follow-up in patients with medium to large reparable RCTs. A high healing rate was observed with the pSCR construct, and no significant complications were reported.