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Técnica del tríceps

Una técnica SpeedBridge™ modificada, con múltiples pasajes de sutura sin nudos y anclas SwiveLock® proporcionan un fuerte reparación. Una técnica alternativa de reparación es el uso de puntos de tracción por el tendón que se pasan a través de dos pequeños túneles transóseos. Las suturas se cruzan sobre el tendón para crear una construcción puente de sutura y se completa con anclas sin nudos SwiveLock.

Shoulder

Arthroplasty Shoulder

Elbow

Imaging and Resection

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A comprehensive overview of a product team’s portfolio.

Ein umfassender Überblick über das Portfolio eines Produktteams.

Kataloge

Visão geral e abrangente do portfólio de produtos de cada segmento.

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Descripción general y completa sobre la cartera de productos de cada segmento. 

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Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

A step-by-step demonstration of how a product would (or could) be used in a surgical technique.

Eine schrittweise Demonstration, wie ein Produkt in einer Operationsanleitung verwendet werden würde (oder könnte).

Operationsanleitungen

Demonstração passo a passo de como um produto seria utilizado em uma técnica cirúrgica.

Guias de técnicas cirúrgicas

Demostración paso a paso de cómo se utilizaría un producto en una técnica quirúrgica.

Guías de técnicas quirúrgicas

Surgical Technique Guides

Transosseous/SpeedBridge™ Triceps Repair

Paul E. Caldwell, MD, (Richmond, VA) demonstrates his repair technique for a delaminated triceps tear with a SpeedBridge™ construct. A single FiberTape® suture is added to the double loaded 4.75 mm BioComposite™ SwiveLock® anchors for the medial row.

video

A video recording of a surgical technique on a live patient in an operating room setting or a cadaveric demonstration.

Eine Videoaufnahme einer Operationsanleitung an einem lebenden Patienten oder Patientin in einem Operationssaal oder eine Demonstration an einem Humanpräparat.

Operationstechnikvideos

Gravação em vídeo de uma técnica cirúrgica em um paciente em uma sala de cirurgia ou uma demonstração cadavérica.

Vídeos de técnicas cirúrgicas

Grabación en vídeo de una técnica quirúrgica de un paciente en un quirófano o una demostración cadavérica.

Videos de técnicas quirúrgicas

Surgical Technique Videos

SpeedBridge™ Triceps Repair

This is Paul Caldwell at Tyco Orthopedics and Orthopedic Research of Virginia, and we would like to present our preferred SpeedBridge technique for triceps repair. Here you see the patient positioned in the prone position for distal triceps repair. We utilize a lateral curvilinear incision to approach the elbow. We use electrocautery to maintain meticulous hemostasis through the subcutaneous tissue. We now dissect through the deep fascia using electrocautery. You can now visualize the proximal end of the olecranon as well as the olecranon fossa. The triceps tear is identified. Here you see the deep layer or medial head. This is delaminated in nature. And the more superficial layer or lateral or long heads are visualized with a double clamp. We now plan our proximal fixation. We initially utilize an awl to create our pilot holes for our proximal SwiveLock. Due to the density of the bone will often finish our sockets with a drill. Once our sockets are complete, we load our first 4.75 biocomposite SwiveLock with a FiberTape. This is inserted in the standard fashion within our previously drilled sockets. We then load our second SwiveLock with an additional FiberTape. This is again loaded within the second socket that we previously drilled. This is easily removed. This leaves us with eight FiberWire sutures and four FiberTape sutures for repair. We then utilize a free needle to load each FiberWire suture through the deep layer of the triceps, in a medial to lateral fashion. This gives us a mattress configuration for our proximal fixation. Once the fiber wires are passed through the distal aspect of the triceps, as you can see, we then utilize the same free needle to pass the FiberTape just proximal to the FiberWire sutures that have been previously passed. Once this configuration is complete through the deep layer, we pass the same sutures through the superficial layer of the triceps. We are able to pass this configuration a little more proximal within the superficial layer of the triceps, to reduce this in an anatomic fashion. Here you see the remainder of the FiberWire is being passed. This is our final construct. The triceps is reduced using manual pressure and the medial row sutures are tied in a mattress fashion. The free ends are left long to be incorporated into our distal row. Once our proximal row of fixation has been tied, we then utilize a drill to create two additional socket at the distal aspect of the triceps footprint. We utilize two additional swivel locks and a SpeedBridge configuration to create an anatomic repair of the distal triceps. The free ends of the sutures are cut flush with the bone to create a low profile repair. Here you can see our finished repair. This is our proximal row of sutures tied and then the free ends compressing the repair. We have a very stable anatomic repair which allows early motion of the distal triceps. Our post-op protocol consists of sling wear for the first six weeks. Non-weight bearing with full passive extension and 90 degrees of flexion. After six weeks, the sling is discontinued and flexion is advanced ten degrees per week until full flexion is achieved. We initiate resistance exercises and weight bearing after eight weeks.

James Paci, MD, (Stony Brook, NY) demonstrates a new technique for distal triceps repair using a single, knotless SwiveLock anchor. The construct uses two small bone tunnels and a 4.75 mm BioComposite™ SwiveLock to create a bridging construct that effectively reconstructs the distal triceps tendon footprint.

Distal Triceps Repair Using Knotless SwiveLock®

We start with a standard curvilinear incision about the olecranon, and usually the extent of the incision is a couple of centimeters proximal and a couple of centimeters distal to the olecranon tip. For demonstration purposes today, we'll extend this incision well beyond these margins for orientation purposes. This is a left elbow. This would be the medial side and this would be the lateral side. So the next thing that I'll do at the time of surgery is mark out the footprint of the triceps. But I'll also do then is mark on the undersurface of the triceps the proximal extent of the triceps footprint. And that's for suture passing purposes. Starting at the undersurface of the tendon this is key. The anterior surface of the tricep will pass the first stitch up and through, and then we'll use a standard locking Krakow stitch. Up and down the lateral side of the tendon. So I'll take my first pass here and locking the stitch. We'll then pass up five passes up the tendon and then run back down the lateral edge. And then lock right down the lateral edge of the tendon. In similar fashion, we'll pass a TigerWire suture on the medial edge of the tendon. [00:02:05] Pictures. Pictures. Notes. So at this point, we've passed our FiberWire and TigerWire sutures medially and laterally. And what you can see on the under surface is that all four strands come out at the footprint edge to give us a chance at good full footprint coverage. The next suture that we'll pass is a FiberLink suture, a looped section at the top, and then a single FiberWire type strand at the end, which allows us to use this as a shuttle. And what we'll do is we'll take a free needle. The idea being that we're going to pass this at the same level as your FiberWire sutures through at the footprint level. And what we want after this is passed is to have the loop posteriorly. We've now got a TigerLink to use on the opposite side. And again we're going to pass this at the level of the proximal footprint in between your sutures that were previously passed. And you can see this come through right right around that footprint level. Now we have our sutures set. We have our TigerLink and FiberLink sutures with our loops posteriorly. We have our whip stitches in place and three strands on each side, medially and laterally beneath the tendon. We'll now retract the tendon out of the way and begin with the bony preparation. So at this point, we're ready to drill our medial and lateral two millimeter tunnels. And again, what we want to do with these tunnels is we want an angle that's going to avoid entering the joint. But give us as deep a tunnel through bone as possible. You can see. Now to illustrate where our two tunnels are medially and laterally from the footprint, proximally exiting distally on the undersurface of the ulna at a point between those two tunnels. We'll drill for our SwiveLock anchor again, getting it started, and then aiming distally away from the joint. We have our more medial and more lateral tunnels and our guide hole for our SwiveLock anchor and where they're placed. So we'll now use a Houston type suture passer through our two millimeter tunnels. And we'll pass the three strands from lateral together. This is the the two strands from the lateral FiberWire as well as the strand from the lateral TigerLink suture down through our lateral tunnel. And we're going to leave these loose for the time being as we go back in and in a similar fashion, pass our three medial strands. This will be the TigerWire suture from medially from the whip stitch as well as the FiberLink suture from medial. And we'll pull those three strands through our tunnel. Now you can see how this reduces the proximal extent of the tendon to the footprint. The idea now is to then back pass sutures in such a way to get compression of the tissue on the footprint. So what we'll do is we'll take one of the fiber wires from laterally and one of the tiger wires from medially, and pass those back to the TigerLoop on the lateral side, pulling that TigerLoop strand distally and pulling those sutures through. For a second pass through our lateral tunnel. We'll then take the remaining two, the remaining two strands, and repass those on the medial side using the FiberLink on the medial side. And now what you can see is you have your classic footprint compression type box and x configuration with four strands of fiber wire. Now what we need to do is get our final fixation. And for our final fixation we're going to use a Biocomposite 4.75mm SwiveLock anchor. So first we're going to pass our lateral sutures through the anchor. And what we'll do is we'll pass those in one direction, and then we'll pass the medial sutures through the anchor in the other direction. And this just allows them to lay down very nicely from the tunnels without bunching in the anchor. And then what you can have is your assistants hold the sutures on each side. And basically you're going to walk the sutures down to your tunnel. Hold that and then turn your swivel lock. And you want to make sure that you don't bury this beyond the cortex because you want a good cortical fit. And you can roll it back to make sure that your anchor is not proud, because that could be an annoyance for the patient in a similar fashion that a knot could be in this area. So at this point, our repair is complete. You can see we have full coverage of the anatomic distal triceps footprint. I'm unable to get an instrument beneath the footprint because we have such terrific compression. You can see there's full restoration of function to the distal triceps insertion.

Técnica del tríceps

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Catálogos (1)

Shoulder and Elbow - Next Generation in Repair and Reconstruction 2024

Guías de técnicas quirúrgicas (1)

Transosseous/SpeedBridge™ Triceps Repair

Videos de técnicas quirúrgicas (2)

SpeedBridge™ Triceps Repair

Distal Triceps Repair Using Knotless SwiveLock®

Related Products (4)

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