Avaliação dos resultados do tratamento cirúrgico da rigidez pós-traumática do cotovelo de pacientes esqueleticamente maturos

Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; Silva, Luciana Andrade da; Giunta, Giovanni Di; Watanabe, Lúcio Norio; Checchia, Sérgio Luiz

doi:10.1590/s0102-36162010000600004

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Regarding the elbow flexion-extension ROM gain after 6 months of treatment, we observed a 40°gain, similar to those reported by Higgs et al, 14 Koh et al 22 and Miyazaki et al 23 Ayadi et al 24 observed a 51°gain in flexion-extension ROM in a series of patients undergoing open surgical release, but only 18% of the patients reached functional ROM, while in our study we observed that 42% of patients acquired functional ROM at 6 months of follow-up. Due to this finding, it is important to highlight that when comparing the ROM gain results between studies, it is inversely proportional to pre-operative ROM.…”

Section: Discussionsupporting

confidence: 91%

Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Gracitelli

Guglielmetti

Botelho

et al. 2020

Rev Bras Ortop (Sao Paulo)

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Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p < 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p < 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p < 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p < 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p < 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p = 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

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Section: Discussionsupporting

confidence: 91%

Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Gracitelli

Guglielmetti

Botelho

et al. 2020

Rev Bras Ortop (Sao Paulo)

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“…Post-traumatic elbow stiffness has been recognized to be a common and difficult-to-manage condition that can interfere with patients’ activities and their quality of life (1) . The etiology of post-traumatic stiffness may be multifactorial and may include (among other causes): joint degeneration, heterotopic ossification, post-fracture joint incongruence and contraction of soft tissues (2) .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Treatment of Post-Traumatic Elbow Stiffness

Júnior¹,

Zabeu

Cintra

et al. 2012

Revista Brasileira de Ortopedia (English Edition)

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To evaluate patients undergoing arthroscopic release of a stiff elbow, with discussion of the technique, possible difficulties and risks. Methods: Twenty-four elbow arthroscopy procedures were performed. All the patients were evaluated using goniometry before the operation and six months afterwards and were rated using the Mayo elbow performance score (MEPS). Results: Fifteen men and nine women underwent surgery (14 right elbows and ten left elbows). Their mean age was 34.58 years and length of follow-up, 38.41 months. Their mean gain of range of motion was 43.3° and of MEPS, 85.4. Conclusion: Arthroscopic release might enable better intra-articular viewing and enhance the options for changing strategy during surgery, reducing surgical trauma and enabling early rehabilitation. This technique can reach similar or better results than open surgery. The disadvantages of arthroscopy are the long learning curve and higher cost of the procedure. Neurovascular complications are reported with both techniques. To avoid such problems, the protocol for portal construction must be rigorously followed. Arthroscopic release was shown to be a safe and effective option for achieving range-of-motion gains in cases of post-traumatic stiff elbow.

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“…The etiology of post-traumatic stiffness may be multifactorial and may include (among other causes): joint degeneration, heterotopic ossification, post-fracture joint incongruence and contraction of soft tissues (2) . Many open surgical procedures have been used to treat post-traumatic contracture of the elbow (3)(4)(5)(6)(7)(8)(9) ; however, the surgical route may cause additional damage to soft tissues and increase the risk of recurrence of the contracture, along with difficulty in implementing early physiotherapy because of pain (10) .…”

Section: Introductionmentioning

confidence: 99%