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      Simultaneous Ipsilateral Quadriceps and Triceps Tendon Rupture in a Patient with End-Stage Renal Failure

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          Quadriceps tendon ruptures (QTR) frequently occur in patients with end-stage renal failure, while triceps brachii tendon ruptures (TTR) are less common. This is the first properly documented report of a simultaneous ipsilateral traumatic rupture of both of these tendons.

          Case Report

          A 50-year-old patient, on hemodialysis for end-stage renal failure, fell on his right side. He presented with sudden right knee and elbow pain, with functional impairment of both joints. X-rays showed avulsion-like osseous lesions on the olecranon and patella with a low-riding patella. Ultrasound confirmed complete quadriceps and triceps avulsion ruptures. Both lesions were treated surgically. Fixation was performed with anchors using the Krackow suture technique for both tendons. Postoperative clinical and radiological results were satisfactory, and follow-up was uneventful. The patient regained his preinjury functional level with a complete range of motion of both his knee and elbow.


          Isolated QTR and TTR are frequent lesions in chronic renal failure patients treated with hemodialysis. Simultaneous ipsilateral rupture of both tendons however is extremely rare and should therefore not be overlooked. Surgical treatment is recommended for complete ruptures.

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          Most cited references 26

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          Distal triceps rupture.

          Distal triceps rupture is an uncommon injury. It is most often associated with anabolic steroid use, weight lifting, and laceration. Other local and systemic risk factors include local steroid injection, olecranon bursitis, and hyperparathyroidism. Distal triceps rupture is usually caused by a fall on an outstretched hand or a direct blow. Eccentric loading of a contracting triceps has been implicated, particularly in professional athletes. Initial diagnosis may be difficult because a palpable defect is not always present. Pain and swelling may limit the ability to evaluate strength and elbow range of motion. Although plain radiographs are helpful in ruling out other elbow pathology, MRI is used to confirm the diagnosis, classify the injury, and guide management. Incomplete tears with active elbow extension against resistance are managed nonsurgically. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Good to excellent results have been reported with surgical repair, and very good results have been achieved even for chronic tears.
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            Simultaneous bilateral rupture of the quadriceps tendon.

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              Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism.

              We report a case of a 27-year-old (male) patient with bilateral and simultaneous rupture of the triceps tendons. He was suffering from chronic renal failure secondary to acute glomerulonephritis and for 4 years he underwent maintenance hemodialysis three times a week. This injury is extremely rare, and only one case has been reported in the international literature. Based on previous cases of tendon ruptures in patients with chronic renal failure, we believe that secondary hyperparathyroidism is the primary causative factor in his case. A primary repair was performed using heavy, nonabsorbable sutures passed through holes drilled in the olecranon with the technique described by Levy. The suture line was then protected with a figure-of-eight tension band wire. Our patient obtained full range of motion bilaterally within 3 months.

                Author and article information

                Case Rep Orthop
                Case Rep Orthop
                Case Reports in Orthopedics
                5 August 2018
                : 2018
                1Orthopedic Surgery, Department of Surgery, 5400 Boul Gouin O, Hôpital du Sacré-Cœur de Montréal, Montréal, QC, Canada H4J 1C5
                2Service of Orthopaedics and Traumatology, Lausanne University Hospital, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
                Author notes

                Academic Editor: Dimitrios S. Karataglis

                Copyright © 2018 Kevin Moerenhout et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Funded by: Edouard-Samson Funding
                Funded by: Swiss Orthopaedic Funding
                Funded by: Fonds de Perfectionnement du CHUV
                Funded by: Fondation Profectus
                Case Report



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