The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases

Abstract

PurposeThe aim of this study was to evaluate the results of elbow arthrolysis according to the surgical approach, durability after arthrolysis and the severity of contracture.MethodsThe study includes a cohort of 100 consecutive patients treated in our institution between 1986 and 2008. The indication for surgery was loss of mobility. This was the result of fractures, dislocation, simultaneous fracture/dislocation or other non-traumatic causes. All patients underwent open elbow release via one of four approaches (42 lateral, 44 medial, six combined medial-lateral and eight posterior). They were clinically evaluated at a minimum of 24 months after arthrolysis.ResultsThe average ranges of elbow extension, flexion and arc of motion had increased significantly at the follow up, respectively, by 20°, 16° and 36°. No significant difference was found with regard to surgical approach. However, we noticed significant deterioration of intra-operative average extension and arc of motion (AOM) over the follow up period, respectively, by 13° and 14°. The number of patients with AOM of 100° or more increased from three patients preoperatively to 28 postoperatively.ConclusionsOpen elbow arthrolysis is a successful method of treatment of elbow contracture. Results are durable, but there is some postoperative deterioration of extension gained during surgery. We may anticipate that at the final stage we shall obtain an average of 86 % of intra-operative arc of motion. Patients with the most severe contractures have the best gains.

Steifer posttraumatischer Ellenbogen

“…Von dem intraoperativ erreichten Bewegungsausmaß kann aber i. d. R. im postoperativen Verlauf durchschnittlich nur 86 % gehalten werden [1,5]. Wie oben beschrieben, werden die Aussichten auf den Erfolg einer Arthrolyse dann als besonders hoch eingeschätzt, wenn eine Pathologie klar adressierbar ist.…”

Posttraumatic elbow contracture

“…17 Alternatively, dual medial and lateral approaches may be used provided a minimal skin bridge of 5 cm is observed.…”

The column procedure preserves elbow stability on biomechanical testing

“…Release of the ulnar nerve was consistently combined with its anterior transposition and was never performed prophylactically despite recent reports underlining its benefit [14][15][16]. Arthrolysis of the elbow can be performed using other approaches, most often Kocher approach, as well as combined with exposing the joint from the medial or posterior aspect [17][18][19][20] depending on the underlying pathology [21]. Sequelae of complex injuries, e.g.…”