Simultaneous surgical treatment of the long head of the biceps tendon during operative treatment of proximal humeral fractures

Background. Pathologic conditions of the long biceps tendon can be found within treatment of proximal humeral fractures or as a source of pain after surgery. However, simultaneous surgical treatment at the index surgical intervention is so far not well established. The purpose of this study is to evaluate the results of a simultaneous biceps treatment during plate osteosynthesis of proximal humeral fractures. Materials and methods. Twenty-seven patients were included into this study. In 14 patients (high cosmetic and functional shoulder demand) a biceps tenodesis (LHBTD) was carried out (7 women, 7 men; o57 years). In 13 patients (12 women, 1 man; o72 years) a biceps tenotomy (LHB-TT) was performed. In addition to the range of motion (ROM), the Constant score and the LHB score were evaluated. Results. All 27 patients were investigated after a mean follow-up of 25 months (range: 18-32 months). The ROM did not reveal any significant differences in either group. The Constant score was significantly decreased compared to the non-affected side (CS) without differences between the groups (LBS-TT 77 +/- 9 vs. LBS-TD 77 +/- 14; LBS-TT (CS) 82 +/- 4 vs. LBS-TD (CS) 87 +/- 4). The LHB score showed excellent results for both groups without significant differences (LBS-TT 98 +/- 3 vs. LBS-TD 93 +/- 10). In one patient of each group, an examiner-dependent upper arm deformity was detected. No patient complained of a subjective cosmetic deformity. Conclusion. The simultaneous surgical treatment of the LHB during plate osteosynthesis of proximal humeral fractures shows good clinical and cosmetic results. In a preselected patient population (cosmetic and functional demand) the kind of treatment (LHB tenotomy or LHB tenodesis) is indifferent.