The timing of open surgical release of post-traumatic elbow stiffness

Abstract

Background:Open release of post-traumatic elbow stiffness is effective in restoring elbow function, but there is no guideline on the optimal time point of surgical release so far. The purpose of this article was to summarize the current available literature reporting on the timing of open release of post-traumatic elbow stiffness.Methods:The PubMed, Cochrane Library, and EMBASE were searched with a set of predefined inclusion and exclusion criteria. Manual searches for references were performed to find potential relevant studies. Two authors separately extracted data from all the articles selected.Results:27 articles published between 1989 and 2017 were included with an overall enrollment of 836 patients. We divided all included studies into 3 groups according to the timing of surgical release: group 1 (6–10 months after injury), group 2 (11–20 months after injury), and group 3(>20 months after injury). The mean postoperative Mayo Elbow Performance Score (MEPS) and recurrence rate were similar among the 3 groups; however, the mean gain in arc of motion in group 1 was the highest with the lowest complication rate among the 3 groups.Conclusion:There was a trend toward a shorter waiting time from injury to open arthrolysis from 12 months to 6 months. The shorter waiting period of 6 to 10 months yielded better results. Therefore, early surgical release of stiff elbows is recommended for a shorter rehabilitation time and earlier return to work.Level of evidence: Level IV, Systematic Review.

Post-traumatic elbow stiffness: Pathogenesis and current treatments

“…When open arthrolysis is performed within 10 months from time of injury, better final range of motion is achieved with fewer complications. 41 Patients with significant existing post-traumatic elbow arthrosis achieve less improvement in range of motion from open arthrolysis than those without significant arthrosis. 22 Patients with motion-restricting heterotopic ossification achieve better range of motion than patients without heterotopic ossification, once the block to motion is removed as a part of surgery.…”

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

“…However, the statistical significance of these differences was not analysed in their study. They recommended an early surgical release, so that the patient could have a shorter rehabilitative period and could return to work earlier [ 10 ]. The results of our study are similar.…”

“…Of the remaining 149 patients, 16 were excluded because of refusal to participate or as loss to follow-up. The remaining 133 patients were divided into 3 groups with reference to the older study by Sun et al [ 10 ], with 31 patients in the early release group (ER, operated at 6–10 months after injury) [ 8 , 9 ], 78 in the median release group (MR, operated at 11–20 months), and the remaining 24 in the late release group (LR, operated at > 20 months).…”

“…Several studies have reported an early arthrolysis to be both safe and effective [ 7 – 9 ]. Sun et al reviewed 836 patients across 27 studies with respect to the time interval between injury and surgical elbow release by comparing recurrence rates and the ROM of patients who had undergone early or late release procedures [ 10 ]. They divided the patients of all the included studies into 3 groups depending on whether the arthrolysis was performed at 6–10 months, 11–20 months, or > 20 months after the injury.…”

Estudo randomizado para o tratamento da rigidez pós-traumática do cotovelo: liberação cirúrgica versus reabilitação

“…A principal vantagem deste estudo é ser prospectivo e randomizado com avaliador cego em relação ao tratamento, sendo considerado nível I de evidência, além de ser o primeiro estudo a comparar essas duas opções de tratamento. Outro ponto favorável é o uso de escalas e questionários clínicos padronizados e amplamente utilizados na literatura 19,27,58,64,65,68,81,82,94,95…”