Elbow Capsulectomy for Posttraumatic Elbow Stiffness

Ring, David; Adey, Lauren; Zurakowski, David; Jupiter, Jesse B.

doi:10.1016/j.jhsa.2006.06.009

Cited by 77 publications

(43 citation statements)

References 20 publications

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“…After secondary surgery, however, the ROM achieved was not statistically different and also was within the functional ROM required for activities of daily living. These results are similar to previously published data regarding elbow ROM after capsulectomy for stiffness, which showed restoration of flexion-extension arcs to 103°to 109° [10,26]. Although secondary surgical intervention must be tailored to the individual patient, these data suggest that patients who have vastly diminished ROM that impairs activities of daily living should be considered for secondary surgical procedures, which appear to significantly improve function.…”

Section: Discussionsupporting

confidence: 89%

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

Gupta

Barei

Khwaja

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Studies to date have consisted of small sample sizes and used heterogeneous surgical techniques, which render comparisons difficult and unreliable. Questions/purposes In a group of patients treated under a standard surgical protocol, we sought to determine the early dislocation rate, the range of motion in those not undergoing secondary procedures, the frequency and types of secondary surgical interventions required, the difference in motion between those undergoing secondary surgery and those who did not, and the frequency of heterotopic ossification and patient-reported stiffness. Methods Patients underwent a surgical protocol that involved fixing the coronoid, fixing the radial head if possible, otherwise performing radial head arthroplasty, and repairing the lateral ligamentous structures. Patients were excluded if ipsilateral upper extremity fractures from the humerus to the distal forearm were present. Fifty-two patients had a minimum followup of 6 weeks and were included for the early dislocation rate, and 34 of these (65%) had a minimum of 6 months followup and were included for the rest of the data. Eighteen of the 52 (35%) were considered lost to followup because they were seen for less than 6 months postsurgically and were excluded from further analysis. Chart review was performed to determine the presence of early dislocation within the first 6 weeks after surgery, range of motion in patients not requiring a secondary procedure, the frequency and types of secondary procedures required, the range of motion before and after a secondary procedure if it was required, and postoperative stiffness. Postoperative radiographs were analyzed to determine the presence and severity of heterotopic ossification. Results One of 52 patients sustained a dislocation within the first weeks of surgery (1.9%). Those not undergoing a secondary procedure were able to achieve a flexion arc of 110°and a supination-pronation arc of 148°. Nine of 34 patients (26%) underwent a secondary surgical procedure with stiffness, heterotopic ossification, and ulnar neuropathy being the most common surgical indications. Before secondary surgical procedures, patients had a flexion arc of 57°a nd a supination-pronation arc of 55°, which was less than those only requiring primary surgery alone (p \ 0.001). After secondary surgery, patients were able to achieve a flexion arc of 96°and a supination-pronation arc of 124°, which was not different from those who did not undergo reoperation (p = 0.09 and p = 0.08, respectively). Twentyeight of 34 patients demonstrated evidence of heterotopic ossification on radiographs, whereas 20 patients, including all nine undergoing secondary procedures, reported stiffness at the elbow.

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Section: Discussionsupporting

confidence: 89%

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

Gupta

Barei

Khwaja

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…18 The most common complications of open contracture release include neuropathies, infection, and recurrence of elbow stiffness and/or heterotopic bone. 1,8,12,19,20,52,53,125,127,128,132,134,135,137,138,142 Lateral column procedure. 159 Either a lateral or midline posterior incision is used, fasciocutaneous flaps are elevated and started proximally, and the lateral supracondylar ridge of the humerus is exposed by reflecting the extensor carpi radialis longus (ECRL) anteriorly off the humerus and the triceps off the humerus posteriorly.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…177 Most authors start mobilization of the elbow within 2 days after an open contracture release, 8,51,52,64,65,125,126,128,133,134,137,202 which may be enhanced by sufficient pain control. 8,125,127,132,202,203 Continuous passive motion (CPM) is used by many authors.…”

Section: Postoperative Management and Rehabilitationmentioning

confidence: 99%

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The Posttraumatic Stiff Elbow: A Review of the Literature

Lindenhovius

Jupiter

2007

The Journal of Hand Surgery

Self Cite

145

115

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“…Proper fixation of these fractures is necessary to avoid potential complications, such as forearm deformity (Goh, 2008), elbow stiffness (Ring et al, 2006) and nerve palsy (Ruchelsman et al, 2009). Furthermore, persistent radial head dislocations associated with Monteggia fracturedislocations have been described in the past as being caused by a relative malalignment of the ulna (Cheung and Yao, 2009) which causes entrapment of structures such as the annular ligament, anterior capsule, biceps tendon, and radial and median nerve.…”

Section: Consequences Of the Fracturementioning

confidence: 99%

Type I Monteggia fracture-dislocation in a monk from a 17th-18th century necropolis of Valladolid (Spain)

López

Caro

Pardiñas

2011

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This paper reports the study of the osseous remains of an adult male (30-35 years) from a Spanish urban necropolis dating from the pre-industrial age (17th-18th centuries). We have diagnosed the presence of a severe unreduced forearm fracture, which has been classified as a Type I Monteggia fracture in the left arm. Injury occurred by a complete and poorly resolved ulnar fracture in its upper third. As result of this ulna fracture a radial head dislocation also occurred, creating a new articular surface on the humerus. The ulna also underwent two different types of angulation. The purpose of this study is to evaluate the anatomical changes of the elbow joint bones after a Monteggia fracture, assessing the completeness of functionality on the arm of this man. After the fracture, this individual lived the rest of his life with a permanent dislocation of his radius; therefore, loss of the forearm rotation, cubitus valgus, elbow instability and pain were all present. Movement was limited to an intermediate position or semipronative. A detailed description of the pathology is also accompanied by a discussion of the historical-cultural context in which this man lived and the common diseases of the population to which he belonged.

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Elbow Capsulectomy for Posttraumatic Elbow Stiffness

Cited by 77 publications

References 20 publications

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

The Posttraumatic Stiff Elbow: A Review of the Literature

Type I Monteggia fracture-dislocation in a monk from a 17th-18th century necropolis of Valladolid (Spain)

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