Arthrolysis for post-traumatic stiffness of the elbow

Abstract

Twelve of 14 patients who underwent arthrolysis of the elbow for post-traumatic stiffness were re-examined after a mean of 62 months. Pain and subjective stiffness were improved. The mean function of the elbow improved from 73 degrees to 112 degrees. Those operated on within a year of their injury improved twice as much as those who had been operated on after a longer period. Arthrolysis may be very rewarding when conservative treatment fails, especially when it is carried out within a year of the injury.

The Posttraumatic Stiff Elbow: A Review of the Literature

“…53 Therefore, patients should preferably be treated within 1 year after onset of stiffness, as better functional results may be expected then. 21,51,53 Open Contracture Release Depending on the plane of elbow contracture, the location of previous elbow incisions, the need for nerve decompression, and the location and extent of heterotopic ossification, the surgeon can choose between medial, lateral, and anterior approaches. Either a posterior midline incision or separate medial and lateral incisions will permit both posteromedial and posterolateral arthrotomies and access to the ulnar nerve and anterior elbow via deep lateral and medial approaches.…”

“…45 The use of nonselective NSAIDs, such as indomethacin, ibuprofen, and naproxen, have all been related to reduced formation of heterotopic bone, in particular in the hip. 46 -50 Although frequently used, 8,21,[51][52][53] the role of NSAIDs in prevention of heterotopic ossification around the elbow is unclear, and a comparative trial is needed. 54 The possible beneficial role of selective NSAIDs that inhibit cyclooxygenase 2 55,56 is uncertain because of the associated risk of serious cardiovascular side effects.…”

Elbow Contracture Release: Open Operative Strategies

“…3,6,7,9,10,42 Most patients achieve a functional arc of motion, and patient satisfaction is high. Patients who have greater restriction of elbow motion before surgery have a greater improvement in the arc of motion after surgery.…”

“…[3][4][5][6][7][8][9][10] In Mohan's report on 200 patients who had elbow ankylosis, 38% of the patients had a previous fracture-dislocation, 30% had isolated fractures, and 20% had a previous dislocation. 11 Elbow contractures also are seen in patients who have inflammatory, degenerative, or septic arthritis.…”

The use of combined lateral and medial releases in the treatment of post-traumatic contracture of the elbow

“…More restriction at the joint and the necessity for difficult treatment modalities arise when the appropriate treatment is delayed. Boerboom et al [1] reported that operative release within a year of the injury is twice as effective as the operation after a longer period. Early postoperative passive ROM exercises, followed by active ROM exercises, have a key role in the treatment.…”