Bony Ankylosis Research Articles

Reliability of Radiologic Classifications of Sequelae of Septic Arthritis of the Hip in Children.

To the best of our knowledge, there is no study comparing the inter and intraobserver reliability of current classifications for postseptic hip sequelae in children. The current study aims to assess the interobserver and intraobserver reliability of four current classifications and identify hips that could not be classified in each classification system. The hip radiographs of 148 consecutive children with sequelae of sepsis of the hip from 2 centers were assessed after a minimum of 2 years of follow-up after sepsis. All hips (affected and normal sides) were classified according to the 4 original descriptions of the authors of the respective classifications. If a hip did not fall into any subtype of the classification, the rater was asked to mark it as nonclassifiable and state the reason for being unable to classify the hip in the respective classification. The intraclass correlation coefficient was computed to assess the reproducibility of each classification. Interrater reliability and intrarater reliability were moderate (0.57 to 0.72) while including all hips. The reliability was poor (0.35 to 0.49) in all 4 classifications, with an evaluation of only affected 180 hips. A few sequelae of infection, including caput valgus (n = 7), acetabular dysplasia (4), joint space narrowing (2), and bony ankylosis (1), were not included in any of the 4 current existing classification systems. The reliability of all current classifications of sequelae of septic arthritis of the hip is moderate. A proportion of sequelae do not find a place in all current classifications. Level III.

Contributions of jaw functional orthopedics in temporomandibular joint ankylosis (TMA) – clinical case report

Temporomandibular joint (TMJ) ankylosis is one of the most disabling pathological conditions that can occur in the maxillofacial region, often occurring at an early age, limiting growth and causing facial deformity, which significantly affects the quality of life of the individual. The objective of the study was to evaluate the contribution of Jaw Functional Orthopedics (JFO) in TMJ ankylosis after the surgical phase. The case of a 7-year-old female patient diagnosed with bilateral condylar ankylosis (fibrous ankylosis on the right side and bony ankylosis on the left side) is presented. On clinical examination, facial asymmetry, retrognathia, muscle contraction and opening limitation were observed. Treatment consisted of temporalis muscle flap rotation surgery with condylectomy and coronoidectomy, physical therapy, and functional therapy with OFM. The clinical results at 4 months of follow-up suggest significant progress in oral opening and protrusion. The patient showed a high degree of satisfaction with the results obtained. She is currently continuing with the use of orthopedic appliances to correct the sequelae of ankylosis and improve mandibular kinematics.

Assessment of the role of coronoid in restrictive jaw disorders and physiologic mandibular movements

Introduction: Restricted mouth opening has major health implications, such as malnutrition, difficulty in speech, and poor oral hygiene resulting in a functional shortage of the masticatory system. Reduced mouth opening can occur due to trismus, as in the oral submucous fibrosis (OSMF) condition. Excision of fibrous bands in OSMF leads to reestablishment of the mouth opening. Other than trismus, temporomandibular joint (TMJ) ankylosis is another common condition that causes fibrosis or bony ankylosis between articular surfaces. Coronoidectomy is a useful procedure that various authors nowadays apply. It is the most popular surgical procedure used as a conventional method of treatment, which includes the detachment of temporalis muscle. Materials and Methods: A group of 15 patients with OSMF and TMJ ankylosis with written informed consent were selected for the study and were operated on under general anesthesia. Preoperative and postoperative assessment was done for bite force management, measuring and comparing mandibular movements, and the electromyography (EMG) study. Results: Statistical analysis shows the increase in maximum mouth opening and lateral excursions in OSMF and TMJ ankylosis patients on the seventh, 15th, 90th days, and six months postoperatively treated either without coronoidectomy and with coronoidectomy; however, there was no significant difference was found in mean EMG and bite force readings in both groups. Conclusion: The present study concludes that the coronoidectomy not only increases the mouth opening, but masticatory efficacy is also improved with an increase in mandibular movements postoperatively in patients with OSMF and TMJ ankylosis.

Association of X-ray disease stage with basic patient data, laboratory values and treatment modalities in patients with seropositive rheumatoid arthritis.

To investigate whether the radiographic progression of rheumatoid arthritis (RA) correlates with inflammatory markers and other laboratory values, and its association with treatment modalities. This observational study included 125 patients with seropositive RA. Data were obtained from patients' medical records from the year of 2022. Inclusion criteria were patients with seropositive RA who had attended follow-up with a rheumatologist. Basic patient data were collected: gender, age, duration of RA, hospital admission, systolic and diastolic blood pressure, and X-ray stage of RA. Stages of RA are defined by the American College of Rheumatology and they ranged from stage 1, which represents no destructive changes on X-ray, up to stage 4 where bony or fibrous ankylosis is present. There were no differences in X-ray stages of RA between genders. Patients with a higher X-ray stage were younger and had a longer duration of illness. Patients in stages III and IV had higher systolic blood pressure (BP), patients in stage IV had higher diastolic BP. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were higher in X-ray stages II-IV compared to stage I. The patients treated with methotrexate had higher radiographic stages. X-ray changes can be associated with CRP and ESR levels, since structural damage is related to RA disease activity and functional disability. The use of newer treatment modalities may be required to stop the radiographic progression of RA.

Complete elbow ankylosis secondary to heterotopic ossification: operative management leads to fair to excellent long-term outcomes

BackgroundHeterotopic ossification (HO) in the elbow, often caused by trauma or neurogenic factors, can lead to limited range of motion and physical impairment, while severe cases may result in debilitating loss of function. Complete bony ankylosis of the elbow, though rare, presents challenges in treatment due to complex anatomy and high recurrence rates, with limited literature on management and outcomes. This study retrospectively investigates cases of elbow ankylosis secondary to HO, assessing long-term functional outcomes following operative intervention and standardized rehabilitation. MethodsA retrospective case series was performed on patients who underwent surgical excision of heterotopic ossification of the elbow at our institution. Outcomes of interest were intraoperative flexion-extension arc, flexion-extension arc at final long-term postoperative follow-up, visual analog scale pain scores at long-term follow-up, and Mayo Elbow Performance Scores at long-term follow-up. Wilcoxon signed-rank test was performed to identify a statistically significant difference between arc of motion achieved intraoperatively and the arc of motion maintained at final long-term postoperative follow-up. ResultsBetween September 1999 and July 2021, 107 patients underwent operative resection for heterotopic ossification around the elbow, with 13 patients (16 elbows) exhibiting complete ankylosis at time of surgery. Patients were followed for a minimum of two years. Long-term outcomes demonstrated an average VAS pain score of 1.4 +/- 1.7, and an average MEPS of 85.9 +/-12.8, with 75% of cases maintaining at least 100 degrees of flexion-extension arc at final long-term postoperative follow-up. On average, the flexion-extension arc of motion at final follow-up was preserved at 95% of intraoperative levels. Patients did have an average residual flexion contracture of 18 +/- 9 degrees at final follow-up. ConclusionSurgical excision for complete elbow ankylosis secondary to heterotopic ossification presents challenges due to potential complications. Our study shows favorable long-term outcomes in pain scores, range of motion, and Mayo Elbow Performance Scores (MEPS). Despite reported complications in the literature, our series exhibited no adverse events, supporting operative excision as a standard treatment with overall fair to excellent outcomes. Further research, particularly involving multicenter, randomized, prospective studies, is warranted to refine protocols and understand predictors for improved outcomes in this patient population.

YAP promotes the early development of temporomandibular joint bony ankylosis by regulating mesenchymal stem cell function

To explore the role of YAP, a key effector of the Hippo pathway, in temporomandibular joint (TMJ) ankylosis. The temporal and spatial expression of YAP was detected via immunohistochemistry and multiplex immunohistochemistry on postoperative Days 1, 4, 7, 9, 11, 14 and 28 in a sheep model. Isolated mesenchymal stem cells (MSCs) from samples of the Day 14. The relative mRNA expression of YAP was examined before and after the osteogenic induction of MSCs. A YAP-silenced MSC model was constructed, and the effect of YAP knockdown on MSC function was examined. YAP is expressed in the nucleus of the key sites that determine the ankylosis formation, indicating that YAP is activated in a physiological state. The expression of YAP increased gradually over time. Moreover, the number of cells coexpressing of RUNX2 and YAP—with the osteogenic active zone labelled by RUNX2—tended to increase after Day 9. After the osteogenic induction of MSCs, the expression of YAP increased. After silencing YAP, the osteogenic, proliferative and migratory abilities of the MSCs were inhibited. YAP is involved in the early development of TMJ bony ankylosis. Inhibition of YAP using shRNA might be a promising way to prevent or treat TMJ ankylosis.

Posttraumatic proximal radioulnar synostosis: Current concepts on the clinical presentations, classifications, and open surgical approaches

In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6–12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.

Stress fracture of the clavicle associated with sternocostoclavicular hyperostosis combined with bony ankylosis of the acromioclavicular joint and ossification of the coracoclavicular ligament.

Sternocostoclavicular hyperostosis (SCCH) has been reported in patients with pustulotic arthro-osteitis, but there are few reports of marked ossification of the lateral part of the clavicle. Here, we report a case of stress fracture in a patient with SCCH with marked ossification of the lateral part of the clavicle. In this case, the clavicular fracture was proximal and no dislocation. Conservative treatment with a clavicle band and the administration of corticosteroids resulted in rapid symptom improvement. Eight months later, the patient had no difficulty in daily life, but X-rays showed that bone fusion was not complete. Therefore, it is necessary to carefully follow-up such patients for any recurrence of symptoms and radiographic changes.

IRE1α inhibits osteogenic differentiation of mouse embryonic fibroblasts by limiting Shh signaling.

This study aimed to investigate the effect of endoplasmic reticulum (ER) stress sensor inositol-requiring enzyme 1α (IRE1α) on the sonic hedgehog N-terminus (N-Shh)-enhanced-osteogenic differentiation process in mouse embryonic fibroblasts (MEFs). Osteogenesis of MEFs was observed by alkaline phosphatase (ALP) staining, alizarin red staining, and Von Kossa staining assays. Activation of unfolded protein response and Shh signaling were examined using real-time quantitative PCR and western blot assays. IRE1α-deficient MEFs were used to explore the effect of IRE1α on N-Shh-driven osteogenesis. N-Shh increased ALP activity, matrix mineralization, and the expression of Alp and Col-I in MEFs under osteogenic conditions; notably, this was reversed when combined with the ER stress activator Tm treatment. Interestingly, the administration of N-Shh decreased the expression of IRE1α. Abrogation of IRE1α increased the expression of Shh pathway factors in osteogenesis-induced MEFs, contributing to the osteogenic effect of N-Shh. Moreover, IRE1α-deficient MEFs exhibited elevated levels of osteogenic markers. Our findings suggest that the IRE1α-mediated unfolded protein response may alleviate the ossification of MEFs by attenuating Shh signaling. Our research has identified a strategy to inhibit excessive ossification, which may have clinical significance in preventing temporomandibular joint bony ankylosis.

The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysis

BackgroundThe main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy interventions in managing TMJ ankylosis. In addition, this study aimed to critically appraise the existing evidence on the prevalence and clinical presentation, physiotherapy intervention approaches, efficacy of physiotherapy interventions, adverse effects, and safety of physiotherapy interventions in TMJ ankylosis management.MethodsAn all-inclusive literature search was conducted using the PubMed, Google Scholar, and Scopus electronic databases. The researchers screened the potential articles and assessed for eligibility based on the reported inclusion and exclusion criteria. The quality evaluation tool for observational cohort and cross-sectional studies developed by the National Institutes of Health (NIH) and the Cochrane Collaboration's Risk of Bias Tool were used to assess the quality of the included studies. Researchers also comprehensively analyzed the data, reported the results, and discussed them according to the predominant themes.ResultsThe primary electronic database search yielded 409 articles, of which 25 were included in this review. A secondary search was conducted from citations of the included studies, yielding 74 articles, of which six were included in the study. A significantly higher prevalence of bony ankylosis than fibrous ankylosis, with an overall effect size of p < 0.00001. In addition, there were significantly more unilateral than bilateral presentations with an overall effect size of p < 0.00001. Moreover, there were 78 reported complications out of 245 subjects according to five included studies demonstrating a significant effect size with p = 0.001 following the treatment protocols.ConclusionThis study highlighted the prevalence of bony ankylosis in temporomandibular joint ankylosis, emphasizing its impact on patients' well-being. On the other hand, the results show that physiotherapy is essential to optimize postoperative outcomes and minimize adverse events such as re-ankylosis. Practitioners and healthcare professionals must monitor postoperative recovery and ensure strict adherence to physiotherapy protocols for optimal outcomes.

Temporal gene expression profiling during early-stage traumatic temporomandibular joint bony ankylosis in a sheep model

BackgroundInvestigating the molecular biology underpinning the early-stage of traumatic temporomandibular joint (TMJ) ankylosis is crucial for discovering new ways to prevent the disease. This study aimed to explore the dynamic changes of transcriptome from the intra-articular hematoma or the newly generated ankylosed callus during the onset and early progression of TMJ ankylosis.MethodsBased on a well-established sheep model of TMJ bony ankylosis, the genome-wide microarray data were obtained from samples at postoperative Days 1, 4, 7, 9, 11, 14 and 28, with intra-articular hematoma at Day 1 serving as controls. Fold changes in gene expression values were measured, and genes were identified via clustering based on time series analysis and further categorised into three major temporal classes: increased, variable and decreased expression groups. The genes in these three temporal groups were further analysed to reveal pathways and establish their biological significance.ResultsOsteoblastic and angiogenetic genes were found to be significantly expressed in the increased expression group. Genes linked to inflammation and osteoclasts were found in the decreased expression group. The various biological processes and pathways related to each temporal expression group were identified, and the increased expression group comprised genes exclusively involved in the following pathways: Hippo signaling pathway, Wnt signaling pathway and Rap 1 signaling pathway. The decreased expression group comprised genes exclusively involved in immune-related pathways and osteoclast differentiation. The variable expression group consisted of genes associated with DNA replication, DNA repair and DNA recombination. Significant biological pathways and transcription factors expressed at each time point postoperatively were also identified.ConclusionsThese data, for the first time, presented the temporal gene expression profiling and reveal the important process of molecular biology in the early-stage of traumatic TMJ bony ankylosis. The findings might contributed to identifying potential targets for the treatment of TMJ ankylosis.

An Extremely Rare Case of Extensive Myositis Ossification: Complete Extra-Articular Ankylosis of Hip Joint

Myositis ossificans, in its literal translation, is defined as an inflammatory ossification of muscle and the neighboring soft tissues. A rare case of post-brain injury ossification of the Gluteus maximus muscle extending from the greater trochanter of the femur to the right wing of the iliac bone, leading to extra-articular bony ankylosis of the hip is reported. A 40-year-old male presented to the Outpatient department with a stiff right hip and restriction of its movements. The patient had a history of cerebral hemorrhage 18 months back and subsequently developed stiffness in the right hip since the last 3 months. X-ray and CT scan revealed the extension of an ossified bar extending between the lateral aspect of the right iliac wing above the right acetabulum and upper 1/3 of the anterior lateral aspect of the femur near the greater trochanter, measuring 1003240 mm. The patient was then allowed to go for rehabilitation with appropriate physiotherapy and anti-inflammatory drugs. Extensive hypertrophic ossification can occur at a totally unrelated site as a consequence of cerebral insult/ head injury.

Sacroiliac Joint Ankylosis Decreases Intervertebral Fusion Rate in L5/S1 Single Intervertebral Transforaminal Lumbar Interbody Fusion.

Background Transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for lumbar spondylolisthesis and intervertebral foraminal stenosis. Sacroiliac joint ankylosis is also known to occur in patients without axial spondyloarthritis. When sacroiliac joint bony ankylosis occurs and sacroiliac joint mobility is lost, stresses from the lower extremities to the lumbar spine are no longer buffered and are expected to be concentrated between the fifth lumbar (L5) and the first sacral (S1) vertebrae. We hypothesized that sacroiliac joint bony ankylosis could adversely affect L5/S1 intervertebral fusion and investigated the postoperative intervertebral fusion rate in single intervertebral TLIF on L5/S1 among patients with bony ankylosis of the sacroiliac joint. Methods Seventy-two patients who had undergone TLIF in the L5/S1 single intervertebral segment since 2014 and had a follow-up of at least one year after surgery were included in the study. Seventy-two patients were divided into the following two groups for comparison: group A consisted of 17 patients with bony ankylosis of the sacroiliac joint on either side on preoperative CT, and group N consisted of 55 patients without ankylosis. We investigated the intervertebral segment fusion rate one year postoperatively. Fisher's exact tests were used for statistical analysis, with a significance level of P < 0.05. Results Twelve patients (71%) in group A and 50 patients (91%) in group N had a fusion of the L5/S1 intervertebral segment one year after TLIF surgery, with a significantly lower rate in group A (P= 0.049). Conclusions We conclude that the presence of preoperative sacroiliac joint bony ankylosis is a risk factor for postoperative intervertebral fusion failure after single-segment TLIF at L5/S1.

Bilateral TMJ Ankylosis: Total Joint Reconstruction in a Patient With Zero Mouth Opening: A Case Report

Objective Present a case of a young patient with bilateral bony ankylosis of the TMJ with zero mouth opening treated with TMJ prosthesis. Methods The ankylosis was studied in detail with computed tomography (CT) and we used virtual surgical planning in the pre-operative phase to provide splints and cutting guides. The patient was treated with bilateral custom-made alloplastic TMJ prosthesis. Results Optimal functional improvement at the 5.5 year follow up after total joint reconstruction without any adverse effects. Mouth opening was 35 mm and the patient was free from pain. CT-images showed no signs of pathology or increased remodeling and bone formation. Conclusion Ankylosis of the TMJ in young and adult population presents unique challenges given the need to account for growth of the mandible and anatomical variations. This report supports the use of total joint reconstruction for end-stage TMJ disease.

Current trends in managing TMJ ankylosis in children-summing it up with a case report.

Temporomandibular joint (TMJ) ankylosis involves fusion of the mandibular condyle to the base of the skull. The treatment of TMJ ankylosis poses a significant challenge because of technical difficulties and a high incidence of recurrence. The experience of managing one such case is reported in light of a review of the literature on this condition. This report describes a case of a 7-year-old girl with inability to open her mouth, diagnosed with unilateral right bony TMJ ankylosis. Key management principles included adequate removal of the ankylotic mass, gap arthroplasty with interpositional temporalis myofascial grafting and post-operative physiotherapy. The patient maintains a satisfactory maximal incisal opening till the present day. A detailed history, clinical and functional examination, radiographic examination facilitating correct diagnosis followed by immediate surgical intervention, and physiotherapy might be beneficial to restore physical, psychological and emotional health of the child patient with TMJ ankylosis.

Surgical outcome of total hip arthroplasty in bony ankylosed hips in ankylosing spondylosis —Systematic review

Incidence of bony ankylosis in hip joint with AS is approximately 40%. Bony ankylosis of hips joints comes with very unique management challenges. There is no specific review article in the literature only for total hip replacement in bony ankylosed hips. We run a literature review to evaluate surgical outcomes and postoperative complications of Total Hip Arthroplasty in Bony ankylosing hip joints. Total five studies, which satisfied inclusion criteria, selected for this review process. Outcome measures like HHS, VAS, ROM and complications were noted and compared. Total number of hips included in this study were 220 in 136 patients. Average patient age was 35.74 years. The mean post-operative Harris Hip Score was 84.9 which was improved from pre-operative HHS 31.1. All studies reported an improvement in hip Range of motion (ROM). Complications were heterotopic ossification, femur fracture, nerve injury, infection, dislocation. Heterotopic ossification (HO) occurred in total 25 hips in 4 studies except Kanniyan et al study. This literature review put forward that total hip arthroplasty of bony ankylosed hips in AS brings improvements in functional outcome measures such as Harris Hip Score, range of motion and ambulatory status.

CHALLENGES OF 'RIGID AIRWAY' IN ANKYLOSING SPONDYLITIS: A CASE SERIES

Ankylosing spondylitis is the complex, multisystemic disorder primarily involving the axial skeleton. Uniform progressive brous ossication of articular and para-articular tissue results in bony ankylosis, loses exibility of spine, ultimately leading to structural and functional impairment. Temporomandibular joint ankylosis with limited neck mobility due to fused cervical spine makes airway management challenging for anesthesiologist. Axial skeletal changes pose neuraxial anesthesia technically demanding and difculty in positioning. These patients may require surgery for hip or spine deformity. We report a series of three ankylosing spondylitis cases with difculties faced in securing airway and how we managed it successfully. Thorough knowledge of the disease process, familiarity with established airway techniques and choosing the most appropriate airway equipment at the right time is crucial.

Clinical profile of hemophilia patients in a tertiary care hospital in Kerala, India: A cross-sectional study

Background: Deficiency of factor VIII (FVIII) (Hemophilia A) and factor IX (Hemophilia B) are the most frequent coagulation defects. The incidence of hemophilia A varies in different regions of India. Aims and Objectives: The present study was done to classify hemophilia A patients by estimating FVIII levels in them and to describe the clinical profile of the patients attending a tertiary care hospital in southern part of India, Kerala. Materials and Methods: A hospital-based cross-sectional study was done on patients with hemophilia A, attending Department of Medicine and Department of Pediatrics from March 2012 to September 2013. Demographic and clinical details were collected using per forma and quantitative assessment of FVIII levels were done using semi-automated blood coagulation analyzer. Results: Out of 90 cases studied, majority of the patients had severe hemophilia (85.6%), followed by mild (10%) and moderate hemophilia (4.4%). Positive family history was seen in 67.8% patients. Median age of the patients at diagnosis was 1 years of age. Most common clinical presentation was found to be hemarthrosis (84.4%) followed by bleeding into muscle (56.7%). Knee joint (75.6%) was the predominantly affected joint. Bony ankylosis (30%), intracranial bleed (14.4%), and retroperitoneal bleed (24.4%) were the most common complications noted. Bleeding manifestations such as gum bleed (24.4%), epistaxis (12.2%), hematuria (37.8%), and ecchymosis (15.6%) were also reported among them. Conclusion: Proportion of severe hemophilia among hemophilia A patients was found to be higher in number than in other parts of the country. Serious complications can result from bleeding into the joints, muscles, brain, or other internal organs. Therefore, promotion of low cost, regular availability of factor concentrates, prophylactic factor replacement, establishing comprehensive care center, and regular training of medical and paramedical staff will help in reducing the complications due to this disease.

Incidental findings involving the temporomandibular joint on computed tomography and magnetic resonance imaging.

The temporomandibular joint (TMJ) is frequently imaged in head and neck computed tomography (CT) and magnetic resonance imaging (MRI) studies. Depending on the indication for the study, an abnormality of the TMJ may be an incidental finding. These findings encompass both intra- and extra-articular disorders. They may also be related to local, regional or systemic conditions. Familiarity with these findings along with pertinent clinical information helps narrow the list of differential diagnoses. While definitive diagnosis may not be immediately apparent, a systematic approach contributes to improved discussions between clinicians and radiologists and better patient management.

DIFFICULTIES IN RECOVERING THE ELBOW JOINT AFTER INJURIES

The unique qualities of the elbow joint as a result of its specific function in the upper extremity make it well studied. The elbow functions by employing the concerted activity of its musculotendinous and bony structures. The shoulder determines the special position of the limb, whereas the elbow regulates the limb length and height to optimize the hand position and function. The evaluation of an elbow injury depends on the correlating symptoms and the history with a careful physical and radiographic examination. The high degree of congruity of the articular surfaces and the relatively small capsular volume makes the elbow joint very complicated. Any significant distortion of the normal anatomy, including bony deformity (congenital post-traumatic), bony or fibrous ankylosis and in some cases, prior surgery (ulnar nerve transposition) plays a major role in its functional recovery. It is often impossible to identify the exact etiologic abnormality responsible for the elbow stiffness and pain. This is one of the most frustrating aspects of treating patients with elbow trauma. There are many theoretic explanations of the possible etiologies, responsible for the common types of elbow joint complications, concerning the anatomic structure, physiologic abnormality or biomechanical alteration responsible for the problems of reaching full range of motion.