Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator

Abstract

Arthrolysis and dynamic splinting have been used in the treatment of elbow contractures, but there is no standardised protocol for treatment of severe contractures with an arc of flexion < 30 degrees . We present our results of radical arthrolysis with twin incisions with the use of a monolateral hinged fixator to treat very severe extra-articular contracture of the elbow. This retrospective study included 26 patients (15 males and 11 females) with a mean age of 30 years (12 to 60). The mean duration of stiffness was 9.1 months (5.4 to 18) with mean follow-up of 5.2 years (3.5 to 9.4). The mean pre-operative arc of movement was 15.6 degrees (0 degrees to 30 degrees ), with mean pre-operative flexion of 64.1 degrees (30 degrees to 120 degrees ) and mean pre-operative extension of 52.1 degrees (10 degrees to 90 degrees ). Post-operatively the mean arc improved to 102.4 degrees (60 degrees to 135 degrees ), the mean flexion improved to 119.1 degrees (90 degrees to 140 degrees ) and mean extension improved to 16.8 degrees (0 degrees to 30 degrees ) (p < 0.001). The Mayo elbow score improved from a mean of 45 (30 to 65) to 89 (75 to 100) points, and 13 had excellent, nine had good, three had fair and one had a poor result. We had one case of severe instability and one wound dehiscence which responded well to treatment. One case had deep infection with poor results which responded well to treatment. Our findings indicate that this method is very effective in the treatment of severe elbow contracture; however, a randomised controlled study is necessary for further evaluation.

The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases

“…We achieved a better gain in amplitude when compared with the group of Tosum et al [7] but worse than Kulkarni et al [23] and Liu et al [5] who had superior results in AOM gain. The difference in our results and two latter series could be caused by more restricted preoperative motion in those two groups.…”

Limited Medial and Lateral Approaches to Treat Stiff Elbows

“…These findings are encouraging compared with the results of other studies that reported improvement of 87° and 89°. 25,26 Furthermore, these authors 25,26 applied a hinged external fixator to assist postoperative rehabilitation (as was done in the current study), and results were much better than those achieved with open release alone. 20 The use of a hinged external fixator in this way differs from its typical use as a salvage to restore joint stability and optimize rehabilitation.…”

Management of the Post-traumatic Stiff Elbow

“…However, subsequent to numerous reports of successful procedures , arthrolysis is now regarded as a reliable, rewarding, evidence-based operation, with low risk of complications. The results in the recent literature are broadly similar, reporting that elbow motion improves in almost all patients, with a mean gain of approximately 50 • , and that the majority achieve the functional arc of 30 • to 130 • [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. The key principles common to almost all studies are the achievement of as much movement as possible at surgery and early motion postoperatively, which requires adequate pain control ( Fig.…”