Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows

Abstract

BackgroundPosttraumatic stiffness of the elbow is a common finding after elbow trauma. Restoration of motion in the posttraumatic stiff elbow is difficult, time consuming, and requires high patient compliance. We have evaluated the long-term effect of an open elbow arthrolysis in the posttraumatic stiff elbow.MethodsWe evaluated 43 patients (14 women, 29 men) with a median age of 47(16–78) years operated with open arthrolysis for a posttraumatic stiff elbow. The median follow-up time was 41(12–204) months. The patients were hospitalized median 12(4–14) days, with daily physiotherapy and NSAID. 36 patients tolerated continuous passive motion (CPM) for 11(0–42) days. 35 patients had a well-functioning brachial plexus anesthesia for median 7(1–18) days. We used the paired 2-tailed T-test in our statistical analysis.ResultsPreoperatively the patients had a median flexion of 110(30–160)°, extension 40(10–90)°, and the total flexion-extension sector (F/E) was 50(0–110)°. At follow-up the patients had a median flexion of 132(75–151)° and extension of 23(8–84)°, which indicate a median gain of 42(−50–114)°. The subjective functional scores (Mayo Elbow Score, EQ5D, Q-Dash, and VAS for pain) were satisfying, and most of the patients (81 %) would have done the operation once again knowing the outcome. We had 5 temporary ulnar neuropraxias, one became permanent and in addition ankylotic, one temporary radial neuropraxia, two superficial wound infections, and one transient hematoma.ConclusionOpen arthrolysis of the posttraumatic stiff elbow is associated with reliable clinical and functional long-term outcomes.

Primary open elbow arthrolysis in post-traumatic elbow stiffness – A comparison of outcomes in severity of elbow injury

“…14 Rehabilitation protocols in other series include immediate mobilisation, 3,11 cast immobilisation followed by mobilisation 5,10 and inpatient CPM with brachial plexus blockade via a catheter. 1,9,12,13 Though some of our cohort received CPM, our main rehabilitation focus is early mobilisation which is supported by recent literature. 3,15 In other series post-operative CPM use resulted in significantly greater inpatient length of stay (range 3e12 days 1,10,13 ) compared to our own (mean 2 days, median 1 day).…”

Post-traumatic stiff elbow

“…The lateral column procedure as described by Mansat and Morrey, 34 or variants thereof, seems to be the most frequently used. 21 , 35 - 37 From a lateral approach, the lateral, anterior and posterior parts may be accessed but not the medial side around the collateral ligament complex and the ulnar nerve. This area frequently needs to be addressed for nerve release and incision of the posterior part of the medial collateral ligament complex, which requires a separate incision or a longer posterior incision from which both the medial and lateral aspects may be approached.…”

Comparative Study of the Functional Outcomes of Combined Medial-lateral Approach Arthrolysis With or Without External Fixation for Severe Elbow Stiffness

“…Open elbow arthrolysis is an effective treatment modality for elbow stiffness [15]. The restoration of the elbow function is mainly achieved through the excision of bony blockage, contracted joint capsule and scar tissue [16,17].…”