Treatment Of Elbow Contractures Research Articles

Discussions About Obstetric Brachial Plexus Injuries

Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the cause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood.

Team Approach: Elbow Contracture Due to Heterotopic Ossification

➢ The elbow is prone to the formation of heterotopic ossification after trauma. Elbow contracture due to heterotopic ossification leads to compromised range of motion and disabilities in performing daily activities.➢ The treatment of elbow contracture is challenging and requires a multidisciplinary assessment.➢ Nonoperative treatment is appropriate for patients within 6 months after the injury to counter the progressive loss of motion during the maturation of heterotopic bone.➢ Operative intervention is indicated if the functional arc of motion cannot be maintained.➢ Open arthrolysis combined with heterotopic excision, ulnar nerve decompression and transposition, and application of a hinged external fixator are effective interventions for improving elbow function.➢ A prolonged and rigorous rehabilitation protocol after elbow release is important for preserving the arc of motion achieved during surgery.

Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator

Arthrolysis and dynamic splinting have been used in the treatment of elbow contractures, but there is no standardised protocol for treatment of severe contractures with an arc of flexion < 30 degrees . We present our results of radical arthrolysis with twin incisions with the use of a monolateral hinged fixator to treat very severe extra-articular contracture of the elbow. This retrospective study included 26 patients (15 males and 11 females) with a mean age of 30 years (12 to 60). The mean duration of stiffness was 9.1 months (5.4 to 18) with mean follow-up of 5.2 years (3.5 to 9.4). The mean pre-operative arc of movement was 15.6 degrees (0 degrees to 30 degrees ), with mean pre-operative flexion of 64.1 degrees (30 degrees to 120 degrees ) and mean pre-operative extension of 52.1 degrees (10 degrees to 90 degrees ). Post-operatively the mean arc improved to 102.4 degrees (60 degrees to 135 degrees ), the mean flexion improved to 119.1 degrees (90 degrees to 140 degrees ) and mean extension improved to 16.8 degrees (0 degrees to 30 degrees ) (p < 0.001). The Mayo elbow score improved from a mean of 45 (30 to 65) to 89 (75 to 100) points, and 13 had excellent, nine had good, three had fair and one had a poor result. We had one case of severe instability and one wound dehiscence which responded well to treatment. One case had deep infection with poor results which responded well to treatment. Our findings indicate that this method is very effective in the treatment of severe elbow contracture; however, a randomised controlled study is necessary for further evaluation.

Treatment of elbow contracture

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Treatment of elbow contractures

Treatment of elbow contractures

Treatment of elbow contractures in burns

Contractures of the elbow after burn injury are frequent and are often connected with other contractions. Surgical correction must take into consideration the topography, the likelihood of possible heterotopic ossification and the condition of the surrounding skin. A study of 66 contractures allowed us to reach the following conclusions: 1. 1. Linear contractures surrounded by normal skin require IC-type local flaps. 2. 2. Widespread contractures can be treated with thoracic flaps if healthy skin remains or else with the ‘backwards flap’. 3. 3. Surgery on existing associated heterotopic ossification must be in two stages starting with the cutaneous step.