Static Progressive Splinting for Posttraumatic Elbow Stiffness

Abstract

To determine the value of static progressive splinting in helping patients with posttraumatic elbow stiffness regain functional motion and avoid operative treatment for stiffness. Retrospective case series. Level I Trauma Center. Over a 3-year period, 29 consecutive patients with elbow stiffness after trauma (flexion contracture greater than 30 degrees or flexion less than 130 degrees) were treated with static progressive elbow splinting when a standard exercise program was no longer achieving gains in motion. Three patients were treated after the injury alone; 14 were treated after operative treatment of the initial injury, and 12 after a secondary operative contracture release for posttraumatic stiffness. Splinting was initiated on an average of 55 days (range, 15 to 200 d) after injury or operative treatment. Ulnohumeral range of motion before and after splint treatment. The flexion arc improved from 71 degrees (range, 0 to 100 degrees) before splinting to 112 degrees (range, 20 to 150 degrees) after splinting. After splinting, 3 patients had a flexion contracture greater than 30 degrees and 10 patients (34%) had fewer than 130 degrees of flexion. Only 3 patients-2 with heterotopic bone and 1 with an associated ulnar neuropathy-requested an operation to address elbow stiffness. Patients who were splinted after the initial injury (n=17, average improvement (fl-ext)=51+/-37 degrees) regained greater motion during splint wear than patients treated after elbow capsulectomy (n=12, average improvement (fl-ext)=22+/-24 degrees). Static progressive splinting can help gain additional motion when standard exercises seem stagnant or inadequate, particularly after the original injury. Operative treatment of stiffness was avoided in most patients.