Open Elbow Arthrolysis for Post-traumatic Elbow Contracture (original) (raw)
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Journal of Clinical Orthopaedics and Trauma, 2021
Stiffness is a sequelae of elbow trauma. Arthrolysis may be considered to increase range of movement (ROM). Little is published on the outcomes/complications of elbow arthrolysis. We present our series of primary open arthrolysis in posttraumatic elbow stiffness. Methods: A consecutive series of patients that underwent primary open arthrolysis for posttraumatic elbow stiffness in our unit (2011e2018) were analysed. All procedures were performed by an elbow surgeon. Postoperative rehabilitation followed protocol with early motion; continuous passive motion (CPM) was utilised if requested. Data collected included patient demographics, traumatic injury type, arthrolysis technique, preoperative, intraoperative and postoperative elbow ROM, complications and postoperative Oxford Elbow Score (OES). Results: 41 patients were included. 59% were male. Mean age at time of arthrolysis was 43 years (range 12e79 years). Mean duration of follow-up was 53 months (range 8e100 months). Median duration from time of injury to arthrolysis was 11 months (range 2e553 months). Mean preoperative flexion-extension arc (FEA) was 70 , improving to 104 postoperatively (p < 0.001). Mean preoperative pronosupination arc (PSA) was 125 , improving to 165 postoperatively (p < 0.001). Mean postoperative OES was 37 (n ¼ 28). Complication rate was 24% with 7 recurrence requiring surgery, 2 nerve injuries and 1 infection. CPM, 10 patients, saw mean FEA improvement of 56. Mean PSA improvement was 36. Complication rate for these patients was 40%. Severe traumatic injury was associated with increased preoperative stiffness (FEA 61 vs 84 , PSA 111 vs 149) but larger improvements in ROM (postoperative FEA 98 [p < 0.001], PSA 165 [p < 0.001]). Conclusion: This series demonstrates improvement in elbow ROM following open arthrolysis with significantly higher gain in pronosupination for those withsevere injury. Moderate results were seen in a patient reported outcome measure. Patients considering arthrolysis should be counselled regarding expectations/complication rate.
Clinical outcomes after posterior open elbow arthrolysis for posttraumatic elbow stiffness
Archives of trauma research, 2014
Loss of motion is a well-known complication after elbow trauma and in severe cases, arthrolysis of elbow is the procedure of choice. The posterior approach might have some advantages especially in post-traumatic patients who have undergone the same surgical approach in the past. The aim of this study was to evaluate the short-term outcomes of elbow arthrolysis through posterior approach. Moreover, we assessed the effect of operation on the patients' quality of life. During a retrospective-cohort study, the medical records of 14 patients (12 men, two women) whose range of movement had been limited post-traumatically and had undergone elbow arthrolysis with posterior approach were reviewed. Before intervention, the patients had a flexion less than 100 degrees or an extension lag of 30 degrees or more. For evaluation of the final outcomes, they were invited to participate in our study and the final range of motion, visual analogue score (VAS), disability of arm, shoulder and hand (...
International Orthopaedics, 2013
The aim of this study was to evaluate the results of elbow arthrolysis according to the surgical approach, durability after arthrolysis and the severity of contracture. Methods The study includes a cohort of 100 consecutive patients treated in our institution between 1986 and 2008. The indication for surgery was loss of mobility. This was the result of fractures, dislocation, simultaneous fracture/ dislocation or other non-traumatic causes. All patients underwent open elbow release via one of four approaches (42 lateral, 44 medial, six combined medial-lateral and eight posterior). They were clinically evaluated at a minimum of 24 months after arthrolysis. Results The average ranges of elbow extension, flexion and arc of motion had increased significantly at the follow up, respectively, by 20°, 16°and 36°. No significant difference was found with regard to surgical approach. However, we noticed significant deterioration of intra-operative average extension and arc of motion (AOM) over the follow up period, respectively, by 13°and 14°. The number of patients with AOM of 100°or more increased from three patients preoperatively to 28 postoperatively. Conclusions Open elbow arthrolysis is a successful method of treatment of elbow contracture. Results are durable, but there is some postoperative deterioration of extension gained during surgery. We may anticipate that at the final stage we shall obtain an average of 86 % of intra-operative arc of motion. Patients with the most severe contractures have the best gains.
Assessment Of Results Of Open Arthrolysis In Post Traumatic Stiff Elbows
The Internet Journal of …, 2009
Background: Surgical management of posttraumatic elbow stiffness has been reported with poor outcome following treatment. Elbow arthrolysis done in any age group and even very old cases yield good results. The goal of our study was to assess the outcome in improvement of the range of motion of the elbow after surgical release by a tailor-made approach to yield good result.Materials and Methods: A retrospective and prospective study was conducted between oct 2006 to oct 2008 at department of orthopaedic surgery, G.S.V.M. medical college Kanpur. This study includes 25 cases of elbow stiffness due to various types of injuries. All the cases were treated with elbow arthrolysis if there was no progress after adequate supervised conservative management except in unreduced dislocations. All the cases were followed up for a minimum period of 2 years. Overall outcome was rated with the functional scoring system by Mayo Clinic Performance Index and Krishnamoorthy et. al (1976).Results: Nineteen(76%) out of 25 patients had excellent results with a mean preoperative range of motion of 38.4°,and postoperative range of motion of 106.80° with net gain in range of motion of 68.40° (' t ' test value is 9.33, P < 0.01). One (4%) of the patient had elbow instability. In cases where release was performed from three months to six months had mean gain of 76.92°. Cases in which release was performed after six months had gain of 63.57°. The mean pre-operative Mayo Clinic Performance Index score was 66°±9.35° and mean post-operative score was 95.4°±13.38° with average gain of 29.4°. (t test value 9.005, p<.001). According to Krishnamoorthy et al functional scoring system (1976), 19 patients (76%) achieve good result and 5 cases (20%) had fair result and 1 case (4%) had poor result.Conclusions: In cases of posttraumatic elbow stiffness after a failed initial conservative treatment, early arthrolysis with sequential surgical soft tissue release yields good result than delayed surgery.
Open arthrolysis versus arthroplasty in the treatment of posttraumatic elbow stiffness
Romanian Journal of Rheumatology
Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only on...
Results of open arthrolysis for elbow stiffness. A series of 22 cases
Acta orthopaedica Belgica
surgeons performed open elbow arthrolysis in 30 adult patients (6 women, 24 men, mean age 30.8 years). All cases resulted from severe initial trauma, which had occurred on average 15.5 months previously. Four patients had extrinsic and 18 had mixed contractures ; 13 had heterotopic ossifications. Operative complications included two peroperative joint instabilities and 3 transient nerve palsies. Seven elbows were remobilized under anaesthesia, one month after the arthrolysis. Twenty-two patients could be reviewed, on average 56 months after the arthrolysis. Seventy seven percent of the patients were satisfied. At final follow-up, the average arc of flexion-extension was 95° ± 15°( average flexion 120° ± 13°, average flexion contracture 31° ± 6°), with a mean improvement of 51° relative to the preoperative range (p < 0.001). The average arc of forearm rotation at final follow-up was 151° ± 23°, with a mean improvement of 41° (p < 0.05). No patient suffered persistent weakness or instability. The average VAS was 5/10, the average MEPI score 76, with 6 excellent, 6 good, 6 fair and 4 poor results, mainly because of persisting pain. The average DASH score was 31.6 and the average SF-36 was 66. Significant correlations were observed between VAS and DASH, MEPI and SF-36. This series demonstrates that open arthrolysis may restore acceptable elbow motion in young active patients presenting with elbow stiffness following major trauma. However, full restoration of motion is rare ; only 18% of the patients regained the functional arcs of motion reported by Morrey, but the majority were satisfied, given their preoperative degree of elbow stiffness. The ultimate result from both the patient's and the surgeon's perspectives is strongly dependent on persisting pain, which was frequent in this series and influenced the DASH, MEPI and the SF-36 scores. Arthrolysis did not address the issue, if pain was the chief complaint.
Arthroscopic arthrolysis for posttraumatic elbow stiffness
Journal of Shoulder and Elbow Surgery, 2011
Background: Loss of motion of the elbow joint is a common finding after elbow trauma. Restoration of motion of the posttraumatic stiff elbow can be a difficult, time-consuming, and costly challenge. Arthroscopic capsular release of stiff elbows has recently been introduced as a safe but technically demanding technique. The outcome in 27 patients treated by arthroscopic capsular release was assessed. Materials and methods: We evaluated 27 patients (17 women) who were an average age of 42 years (range, 14-65) at 3, 12, and 24 months after arthroscopic capsular release of a posttraumatic stiff elbow. Range of motion (ROM) and Elbow Function Assessment (EFA) were measured. Results: Before the arthroscopic procedure, the mean flexion was 123 (SD 8 ), extension was 24 (SD 9 ), and total ROM was 99 (SD 11 ), and after surgery, flexion improved significantly to 133 (SD 5 ), extension to 7 (SD 6 ), and total ROM to 125 (SD 10 ). The mean (SD) EFA showed improvement from 69 (SD 4) preoperatively to 91 (SD 4) postoperatively. The postoperative outcomes at 3, 12 and 24 months were similar. One postoperative superficial infection of the lateral portal occurred and was successfully treated with oral antibiotics. No vascular or neurologic complications were noted. Discussion: Historical data underscore the fact that arthroscopic release of posttraumatic elbow contracture is technically demanding but can effective improve the elbow arc of motion. Conclusion: Arthroscopic capsular release of the elbow is a safe and reliable treatment for patients with a posttraumatic elbow contracture.
Open versus Arthroscopic Treatment of Post-Traumatic Stiff Elbow
Open Journal of Orthopedics, 2014
Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11˚ to 103.94˚. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46˚ to 101.53˚. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthroscopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.
Posttraumatic contracture of elbow treated with intraarticular technique
Archives of Orthopaedic and Trauma Surgery, 2003
Background: Posttraumatic contracture of the elbow (either flexion or extension) is sometimes very disabling. However, an absolutely convincing surgical technique has not yet been defined in the literature. We developed an intraarticular technique to concomitantly treat both intraarticular and extraarticular lesions with one posterior incision. Methods: Twenty consecutive adult patients were treated. After the olecranon was osteotomized, all intraarticular pathologies and the anteroposterior capsule were corrected completely. The olecranon was then stabilized with the modified tension band wiring technique. Immediately postoperatively, continuous passive movement was performed, and range-of-motion exercise of the elbow was encouraged continuously. Results: All 20 patients were followed up for a median of 3.8 (range 2.1-6.6) years. The satisfactory rate was 95% (19 of 20, p<0.001). The flexion contracture improved from an average of 42 to 13 deg (p<0.001), and the maximal flexion improved from an average of 89 to 131 deg (p<0.001). The arc of motion improved from an average of 47 to 118 deg (p<0.001). The sole unsatisfactory patient still had 20-110 deg of arc of motion. There were no evident complications noted. Conclusion: Compared with other techniques, we recommend this one due to its high satisfactory rate and low complication rate.
The Outcome of Open Surgical Treatment of Posttraumatic Elbow Stiffness
Posttraumatic stiff elbow is a frequent and disabling complication and causes difficulty in placement of hand in space and hence limits the functional capacity. It poses challenges for management. The initial management should be nonoperative and surgical treatment is indicated when conservative measures for a reasonable period fail to achieve the functional range of motion. The aim of this study was to assess the outcome of open arthrolysis of posttraumatic elbow stiffness