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

Abstract

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.