The Posttraumatic Stiff Elbow: A Review of the Literature

Lindenhovius, Anneluuk L.C.; Jupiter, Jesse B.

doi:10.1016/j.jhsa.2007.09.015

Cited by 139 publications

(120 citation statements)

References 187 publications

(277 reference statements)

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Section: Discussionmentioning

confidence: 99%

“…2,10,11 Conservative management requires substantial dedication and has had mixed success. 2,10,11 When surgical treatment is selected, intraoperative motion achieved at the time of release is difficult to maintain. 2,10,11 Interestingly, the severity of a contracture seems to depend largely on the biologic response of the affected individual, as different patients develop varying degrees of fibrosis, even under similar conditions.…”

Section: Discussionmentioning

confidence: 99%

“…2,10,11 When surgical treatment is selected, intraoperative motion achieved at the time of release is difficult to maintain. 2,10,11 Interestingly, the severity of a contracture seems to depend largely on the biologic response of the affected individual, as different patients develop varying degrees of fibrosis, even under similar conditions. 12 As with other fibrotic conditions, pharmacologic interventions may have the potential to alter the fibrotic cascade and thereby prevent and/or treat joint contractures.…”

Section: Discussionmentioning

confidence: 99%

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New rabbit knee model of posttraumatic joint contracture: Indirect capsular damage induces a severe contracture

Nesterenko

Morrey

Abdel

et al. 2009

Journal Orthopaedic Research

122

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Reported models of joint contracture fail to result in severe motion loss. Our purpose was to develop a rabbit model of knee contracture and compare it to another well-accepted model to determine if more severe stiffness can be achieved. Sixteen skeletally mature New Zealand White female rabbits had their right knee operated to create 3-mm defects on the noncartilaginous portions of the femoral condyles, hyperextend the joint to disrupt the posterior capsule, and immobilize the joint in maximum flexion with a Kirschner-wire for 8 weeks (group I). Sixteen additional rabbits were operated on using an identical protocol except for the absence of capsular injury (group II). In each group, mechanical testing was performed at the time of Kirschner-wire release in eight animals, and 16 weeks after remobilization in eight animals. At immobilization release, the average contracture was 76 AE 248 in group I versus 20 AE 108 in group II (p < 0.001). Sixteen weeks after remobilization, the mean contracture was 49 AE 158 group I versus 11 AE 108 in group II (p < 0.001). When associated with bone perforations and immobilization in forced flexion, injury to the posterior capsule results in a severe contracture in the rabbit knee. ß

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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New rabbit knee model of posttraumatic joint contracture: Indirect capsular damage induces a severe contracture

Nesterenko

Morrey

Abdel

et al. 2009

Journal Orthopaedic Research

122

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“…consisting of the pathologic formation of mature lamellar bone that is histologically identical to native bone [14]. The prevalence of HO of the elbow has been reported to range from 3% in simple dislocations to 45% in patients with distal humerus fractures [1,12,16].…”

Section: Introductionmentioning

confidence: 99%

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Wiggers

Helmerhorst

Brouwer

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood. Questions/purposes We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatment-related factors associated with the development of HO severe enough to restrict motion after surgery for elbow trauma. We also determined what percentage of the variation in HO restricting motion was explained by the variables studied. Methods Between 2001 and 2007, we performed surgery on 417 adult patients for elbow fractures; of these, 284 (68%) were available for radiographs at a minimum of 4 months and clinical review at a minimum of 6 months after surgery (mean, 7.9 months; range, 6-31 months). HO was classified according to the Hastings and Graham system. Patients with HO restricting motion (defined as a Hastings and Graham Class II or III) were compared with patients without HO restricting motion in terms of demographics, fracture location, elbow dislocation, open wound, mechanism of injury, ipsilateral fracture, head trauma, time from injury to surgery, number of surgeries within 4 weeks, total number of surgeries, bone graft, and infection, using bivariate and multivariable analyses. A total of 96 patients had radiographic HO, and in 27 (10% of those available for followup), it restricted motion. Results There were no patient-related demographic factors that predicted the formation of symptomatic HO. Ulnohumeral dislocation in addition to fracture (odds ratio, 2.38; 95% CI, 1.01-5.64; p = 0.048) but not fracture location was associated with HO. Longer time from injury to definitive surgery and number of surgical procedures in the first 4 weeks were also independent predictors of HO (p = 0.01 and 0.004, respectively). These factors explained 20% of the variance in risk for HO restricting motion. Conclusions HO restricting motion after operative elbow fracture treatment associates with factors that seem related to injury complexity, in particular, ulnohumeral dislocation, delay, and number of early surgeries; however, a substantial portion of the variation among patients with elbow fracture who develop restrictive HO remains unexplained. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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“…In the anatomical context of a contracted joint, the joint capsule is regarded as the critical motion-limiting structure (1). In patients with chronic elbow contractures following trauma, the fibrotic joint capsule becomes markedly thickened and disorganized compared with normal elbows (2,3).…”

Section: Introductionmentioning

confidence: 99%

Effect of pERK2 on extracellular matrix turnover of the fibrotic joint capsule in a post-traumatic joint contracture model

Sun

Fan

2015

Experimental and Therapeutic Medicine

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Abstract. Lentivirus (LV)-mediated extracellular signal-regulated kinase (ERK)2 small interfering RNA (siRNA) has previously been demonstrated to reduce post-traumatic joint contractures: In the present study, the effect of ERK2 siRNA on extracellular matrix turnover within fibrotic joint capsules in post-traumatic joint contractures was examined. Rats were randomly assigned to one of three groups as follows: The non-operated control (CON), operated contracture (ORC) and contracture-treatment (CNT) groups. Representative post-traumatic joint contracture was created through 8 weeks of immobilization following intra-articular injury. In the CNT group, LV-mediated ERK2 siRNA was injected into the model knee at days 3 and 7 after surgery. The posterior joint capsule was examined by western blotting, histology and immunohistochemistry to evaluate alterations in ERK2, phosphorylated (p)ERK2, total collagen, collagen I, collagen III, matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-13. In the ORC group, pERK2 was elevated and total collagen, collagen I, MMP-1 and MMP-13 were significantly increased (P<0.01 vs. CON group); however, these were significantly decreased in the CNT group, and pERK2 was downregulated (P<0.01 vs. ORC group). Collagen III and TIMP-13 were markedly decreased in the ORC group (P<0.01 vs. CON group), but elevated in the CNT group (P<0.01 vs. ORC group). The present res4ults demonstrate unique pathological changes of the fibrotic joint capsule that are responsible for joint contracture following traumatic injury, and reveal that extracellular matrix turnover can be affected by pERK2.

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The Posttraumatic Stiff Elbow: A Review of the Literature

Cited by 139 publications

References 187 publications

New rabbit knee model of posttraumatic joint contracture: Indirect capsular damage induces a severe contracture

New rabbit knee model of posttraumatic joint contracture: Indirect capsular damage induces a severe contracture

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Effect of pERK2 on extracellular matrix turnover of the fibrotic joint capsule in a post-traumatic joint contracture model

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