Reinsertion of a ruptured distal biceps through a modified 2-incision approach is a well-accepted method of repair. Only 1 large series has focused specifically on the complications associated with this approach, and the authors found no instances of radioulnar synostosis. In a retrospective review of 45 consecutive cases, 12 of 45 patients (27%) experienced 14 postoperative complications, including nerve dysfunction in 7, functional radioulnar synostosis in 3, loss of motion unrelated to heterotopic ossification in 2, early rerupture in 1, and reflex sympathetic dystrophy in 1. The incidence of complications for patients having surgery from 0 to 14 days after injury was 20% (6 of 30), whereas that of patients having surgery 15 or more days from injury was 40% (6 of 15); however, this difference was not significant (P = .16). Reinsertion of a distal biceps through a 2-incision approach should be performed within 2 weeks of the injury, when possible. Functional synostosis occurs more frequently than previously reported (7%).