Open arthrolysis is an effective way to treat elbow stiffness. However, previous approaches led to significant surgical trauma. The goal of the current study was to evaluate the outcome of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation to treat elbow stiffness. A total of 18 patients (18 elbows) with elbow stiffness were retrospectively reviewed. The same inclusion and exclusion criteria were used for all patients. Preoperatively, the mean flexion arc was 43°±28° and the mean Mayo Elbow Performance Score was 62 points. Limited medial and lateral approaches were used to provide safe and complete arthrolysis. The other protocols included ulnar nerve transposition, medial epicondyle osteotomy, radial head resection, ligament repair, and hinged external fixation. Patients were encouraged to begin early rehabilitation 24 hours after surgery. At a mean follow-up of 20 months, the flexion arc improved to 130°±11° and the mean Mayo Elbow Performance Score was 97 points (15 excellent, 3 good). One patient had elbow instability, but function met the requirements of his daily life. Transient ulnar nerve palsy without infection occurred in 4 patients. With limited medial and lateral approaches, elbow stiffness can be treated effectively with open arthrolysis. This method is trauma controlled. Furthermore, a hinged external fixator can provide sufficient and safe rehabilitation. The use of open arthrolysis with limited medial and lateral approaches combined with hinged external fixation is an effective and safe method to treat elbow stiffness.

mobilization and reapproximation, followed by placement of a rectus fascia sling. We also describe placement of an alloderm graft to aid in the reapproximation of the rectus fascia. Our patient is 70 year old who presented with large volume urinary leakage along with stress urinary incontinence. On physical exam, no erosion was noted suburethrally, however, the mesh was palpable. She underwent a pelvic ultrasound which revealed two distinct areas of mesh at the midurethra. A pelvic MRI was performed which revealed a bilobed diverticulum. Therefore, she underwent surgical management to remove the midurethral slings, resect the wall of the diverticulum and then repair the urethral defect. We demonstrate mobilization of periurethral flaps and confirmation of urethral repair using the Davis double balloon catheter. Following urethral repair, we perform a Pfannenstiel incision to harvest an 8-10 cm segment of rectus fascia. We used a Varco clamp to facilitate placement and absorbable suture to stabilize the midpoint of the graft at the midurethra. After tensioning the graft, we place alloderm to reapproximate the superior and inferior edges of the rectus fascia. Conclusion: Despite a complicated presentation, we conclude that it is possible and safe to resect two midurethral slings, remove a urethral diverticulum, and treat persistent stress urinary incontinence in a single surgical setting.