The medial approach for operative release of post-traumatic contracture of the elbow

Abstract

We treated post-traumatic contracture of the elbow in 13 consecutive patients (14 elbows) by operative release. Through a single medial approach, the posterior oblique bundle of the medial collateral ligament was resected, followed by posterior and anterior capsulectomies. An additional lateral release through a separate incision was required in only four elbows. The results were assessed at a mean interval of 57 months after operation.Before surgery active extension lacked 43° which improved to 17° after operation. Active flexion before operation was 89°, which improved to 127°. The mean arc of movement increased from 46° to 110°. All 14 elbows showed scarring of the posterior oblique bundle of the medial collateral ligament.Neither the interval from injury to operative release nor the age of the patient affected the results. A medial approach is useful to reveal and excise the pathological changes in the medial collateral ligament. It is a safe and effective route through which to correct post-traumatic contracture of the elbow.

Successful Elbow Contracture Release Secondary to Melorheostosis

“…We used the medial approach to release the ulnar nerve in our patient because, when flexion is limited to 90°prior to elbow release, ulnar neuritis frequently develops as patients regain flexion, which may limit further flexion following release of an elbow contracture 20 . The medial approach is also helpful in addressing any fibrous contracture of the posterior oblique ligament of the medial collateral ligament 7,8 ; this approach was helpful in addressing the contracture found close to the hyperostotic lesion in our patient. It is notable that proximal release of the flexor-pronator muscle facilitated the approach to the anterior capsule and Z-plasty was effective in overcoming the long-standing muscle contracture.…”

“…The procedure was performed through a medial approach to the elbow 7,8 . The ulnar nerve was identified and mobilized.…”

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

“…Wada et al [17] stated the benefits of the medial exposure and they found several advantages over the lateral approach. According to Wada et al [17], pathological changes in the posterior oblique bundle of the medial collateral ligament, and anterior and posterior aspects of the elbow joint, can be seen via one medial incision.…”

“…According to Wada et al [17], pathological changes in the posterior oblique bundle of the medial collateral ligament, and anterior and posterior aspects of the elbow joint, can be seen via one medial incision. This incision allows a complete soft-tissue release and excision of loose bodies at the olecranon and coronoid fossae.…”

“…Wada et al [17] reported the superiority of the medial approach in respect to both the anterior and lateral approaches.…”