A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults.

PURPOSE: Triceps tendon avulsion (TTA) is an uncommon injury, and there are no classifications or treatment guidelines available. This study aims to describe a clinicoradiological classification and treatment algorithm for traumatic TTA in adults. The functional outcome of surgical repair has been evaluated too.

METHODS: A retrospective analysis of adult patients with traumatic TTA treated in our institution between 2012 and 2017 was done. We only included complete TTA injuries. Children below 15 years, open injuries, associated fractures, and partial TTA were excluded. The data were obtained from hospital records. The intraoperative findings were correlated with the clinicoradiological presentation for classifying TTA. The functional outcome was analyzed using the Mayo Elbow Performance index and Hospital for Special Surgery elbow score. ANOVA test was used to assess the statistical significance.

RESULTS: There were 15 patients included, including 11 males and 4 females. The mean age was (31.5 ± 9.15) years, and the mean follow-up was (22.4 ± 8.4) months. Fall on outstretched hand was the mode of injury. In 6 patients, diagnosis was missed on the initial visit. TTA were classified as Type 1: palpable soft-tissue defect without bony mass; Type 2: palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on X-ray; Type 3: palpable soft-tissue defect with a bony mass and a large bony fragment on X-ray without extension to the articular surface; and Type 4: an olecranon fracture with less than 25% of the articular surface. An algorithm for treatment was recommended, i.e. transosseous suture repair/suture anchor for Type 1, transosseous suture repair for Type 2, and tension band wiring or steel wire sutures for Types 3 and 4. All the patients achieved good to excellent outcome: the mean Mayo Elbow Performance index was 100 and Hospital for Special Surgery score was 98.26 ± 2.60 on final follow-up.

CONCLUSION: Our clinicoradiological classification and treatment algorithm for TTAs is simple. Surgical treatment results in excellent functions of the elbow. Since it is a single-center study involving a very small number of cases, a multicenter study with a larger number of patients is required for external validation of our classification and treatment recommendations.