Distal Biceps Avulsion Pathway Updated: 10/4/2016
CPT Codes: 24342 Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft

Distal Biceps Repair - Single Incision

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TECHNIQUE STEPS
Preoperative Patient Care
Operative Techniques
E

Preoperative Plan

1

Template repair

  • template placement of the anchor device

2

Execute surgical walkthrough

  • describe key steps of the operation verbally to attending prior to beginning of case.
  • description of potential complications and steps to avoid them
F

Room Preparation

1

Surgical instrumentation

  • anchor device

2

Room setup and equipment

  • mini c-arm on same side as operative extremity

3

Patient positioning

  • supine
  • radiolucent armboard
  • pad all bony prominences
  • place sterile tourniquet
G

Superficial Dissection

1

Mark and start the incision

  • mark and make a 2cm incision distal to elbow crease over biceps attachment

2

Develop interval

  • develop interval between FCR and brachioradialis and palpate radial tuberosity

3

Locate and tag the biceps tendon

  • tag tendon with heavy suture
  • tendon may be retracted requiring accessory proximal incision

4

Identify neurovascular structures

  • identify and protect location of lateral antebrachial nerve
H

Deep Dissection

1

Expose the tuberosity

  • dissect down to the radial tuberosity
  • place retractors

2

Remove any remaining soft tissues

  • clear tuberosity of residual soft tissue
I

Tendon Preparation

1

Locate and tag the biceps tendon

  • tag tendon with heavy suture
  • tendon may be retracted requiring accessory proximal incision

2

Identify neurovascular structures

  • identify and protect location of lateral antebrachial nerve

3

Place anchor device

  • deliver anchor device into tuberosity

4

Secure tendon using anchor device to tuberosity

J

Bone Preparation

1

Drill guide pin

2

Use fluoroscopy for placement confirmation

  • confirm proper placement in tuberosity with fluoroscopy

3

Measure diameter of tendon

4

Overdrill guide pin

  • overdrill guide pin with appropriate sized bit through near cortex
K

Tendon Fixation

1

Place anchor device

  • deliver anchor device into tuberosity

2

Secure tendon using anchor device to tuberosity

L

Wound Closure

1

Irrigation and hemostasis

  • copiously irrigate the wound
  • perform meticulous hemostasis

2

Deep closure

  • close subcuticular tissue
  • avoid button-holing
  • atraumatically handle tissue

3

Superficial closure

  • close skin
  • +/- local anesthetic

4

Dressings and immobilization

  • apply sterile dressing
  • apply splint and sling
Postoperative Patient Care
 

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