Retrospective Study on the Risk of Nerve Injury After Distal Biceps Tendon Repair Using Cortical Button

Background: Distal biceps tendon ruptures are relatively rare injuries that typically require surgical intervention to restore flexion and supination strength. Concerns have been raised regarding the risk of nerve injuries, particularly the posterior interosseous nerve (PIN), associated with the use of cortical buttons in distal biceps repair. This study aimed to estimate the incidence of PIN injury as well as injuries to the lateral cutaneous nerve of the forearm and superficial branch of the radial nerve following distal biceps repair using cortical buttons. Methods: A retrospective review was conducted on all patients who underwent distal biceps repair with cortical buttons at a district general hospital between January 2014 and May 2022. Patient data, including age, gender, time from injury to surgery, type of procedure, and postoperative nerve injuries, were collected. The incidence of nerve injuries was analyzed, and the outcomes were assessed during postoperative follow-up visits. Results: Ninety-six male patients were included in the study, with an average age of 45.6 years. The average time from injury to surgery was 22.6 days. All patients underwent primary repair except for two patients who underwent reconstruction with hamstring grafts. None of the patients experienced a PIN injury. However, 16 patients (16.7%) developed lateral cutaneous nerve injuries of the forearm, and three patients (3.1%) had superficial radial nerve injuries. Conclusion: Our study, encompassing a large cohort of patients over an eight-year period, demonstrates the safety of distal biceps repair using cortical buttons with regard to PIN nerve injury. However, there were incidences of lateral cutaneous nerve of the forearm and superficial radial nerve injuries, consistent with previous studies.