Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach

Abstract

Varying surgical techniques, patient groups and results have been described regards the surgical treatment of post traumatic flexion contracture of the elbow. We present our experience using the limited lateral approach on patients with carefully defined contracture types.Surgical release of post-traumatic flexion contracture of the elbow was performed in 23 patients via a limited lateral approach. All patients had an established flexion contracture with significant functional deficit. Contracture types were classified as either extrinsic if the contracture was not associated with damage to the joint surface or as intrinsic if it was.Overall, the mean pre-operative deformity was 55 degrees (95%CI 48 -61) which was corrected at the time of surgery to 17 degrees (95%CI 12 -22). At short-term follow-up (7.5 months) the mean residual deformity was 25 degrees (95%CI 19 -30) and at medium-term follow-up (43 months) it was 32 degrees (95%CI 25 -39). This deformity correction was significant (p < 0.01). One patient suffered a post-operative complication with transient dysaesthesia in the distribution of the ulnar nerve, which had resolved at six weeks. Sixteen patients had an extrinsic contracture and seven an intrinsic. Although all patients were satisfied with the results of their surgery, patients with an extrinsic contracture had significantly (p = 0.02) better results than those with an intrinsic contracture. (28 degrees compared to 48 degrees at medium term follow up).Surgical release of post-traumatic flexion contracture of the elbow via a limited lateral approach is a safe technique, which reliably improves extension especially for extrinsic contractures. In this series all patients with an extrinsic contracture regained a functional range of movement and were satisfied with their surgery.

Outcomes of open arthrolysis of the elbow without post-operative passive stretching

“…22 The mean improvement in ROM of 40° was comparable to that in previously reported studies. 13,20,21,[23][24][25] Nine patients who had a pre-operative ROM of < 30° achieved the greatest improvement, with a final mean flexion arc of 92°. This counterintuitive finding, first identified by Morrey in his classic paper in 1990, 9 has also been reported in other series.…”

“…as previously used by Brinsden, Carr and Rees. 13 For those patients who attended for review, all measurements of ROM were performed using a handheld goniometer by a single observer (BAD) who had not been involved in the surgery. Patients were followed up at six weeks, three months and one year.…”

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.…”

“…Reports of complications from open arthrolysis vary from 0% to 44%, although most of the complications reported are relatively minor [18,22,[24][25][26][27][28][29][30][31][32][33][34][35][36]50,51]. Wound infection, dehiscence, haematoma and seroma are the commonest problems and are more likely in more complex cases.…”

The time point in surgical excision of heterotopic ossification of post-traumatic stiff elbow: recommendation for early excision followed by early exercise

“…3,6,9,15,35,44 If nonoperative management fails to achieve functional ROM, surgery is necessary to restore elbow function. 2,7,11,15,21,28,37,42,45 However, with a high incidence of recurrence, surgical excision of HO is usually delayed for 12 to 24 months (from injury to operation) until the maturation of bone occurs. 1,4,14,18,20,22,30,31,34,36,38,39,41,43 During this period, the function of the elbow is significantly impaired by secondary contracture.…”