Prospective outcome analysis following tenodesis of the long head of the biceps tendon along with locking plate osteosynthesis for proximal humerus fractures

Injury. 2019 Mar;50(3):681-685. doi: 10.1016/j.injury.2019.02.003. Epub 2019 Feb 10.


Background: Fractures of the proximal humerus are often associated with lesions of the long head of the biceps (LHB) tendon. This often leads to prolonged shoulder pain. Hence, many surgeons decide to perform a tenodesis of the LHB tendon simultaneous to ORIF. The purpose of this study was to evaluate the postoperative outcome after interlocking plate fixation and biceps tenodesis for treating proximal humerus fractures.

Methods: 56 patients (38 females, 18 male) suffering from proximal humerus fractures who underwent surgery were retrospectively included. 26 of these 56 patients (19% Neer II, 38% Neer III, 43% Neer IV) were treated with simultaneous tenodesis of the LHB tendon when ORIF using interlocking plate fixation was performed. 30 patients (17% Neer II, 40% Neer III, 43% Neer IV) served as control group receiving only interlocking plate fixation. The patients were asked to complete the Munich Shoulder Questionnaire (MSQ) for evaluation of postoperative shoulder function. Results of the Disabilities of the Arm, Shoulder and Hand (DASH) Score and Shoulder Pain and Disability Index (SPADI) were calculated from the MSQ. Patients were clinically evaluated for a positive O'Brien test and Popeye sign.

Results: The tenodesis group demonstrated significant superior outcome regarding the MSQ (mean 90.47 points vs. 79.41 points, p = 0.006), DASH Score (mean 4.2 points vs. 16.81 points, p = 0.017) and SPADI (mean 94.59 points vs. 83.56, p = 0.045). Flexion, external rotation and the capability of throwing a soft ball were significantly improved in the tenodesis group compared to the control group. The O'Brien test as indicator for lesions of the LHB was positive in fewer patients of the tenodesis group (2/26, vs. 21/30, p = 0.001). There was no significant difference of a positive Popeye Sign.

Conclusion: Our results show evidence of an improved shoulder function when a simultaneous tenodesis of the LHB tendon is performed during treatment of proximal humerus fractures using interlocking plate fixation.

Keywords: Biceps muscle; Long head of the biceps tendon; Plate fixation; Proximal humerus fracture; Tenodesis.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Plates
  • Female
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods*
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / physiopathology*
  • Postoperative Complications / surgery
  • Prospective Studies
  • Retrospective Studies
  • Shoulder Fractures / physiopathology
  • Shoulder Fractures / surgery*
  • Tendons / pathology
  • Tendons / surgery*
  • Tenodesis / methods*
  • Treatment Outcome
  • Young Adult