Treatment Of Post-traumatic Elbow Stiffness Research Articles

Open arthrolysis versus arthroplasty in the treatment of posttraumatic elbow stiffness

Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only one had a markedly improved elbow function with a 90° arc of motion; elbow stiffness had recurred in the other two patients. Of the 5 patients who underwent total elbow arthroplasty, 3 were lost to follow-up; the other 2 patients had a stable elbow, with a fair arc of motion of 60° and 70° respectively, both with a flexion contracture of 20°. Complications included 2 superficial infections, which healed following conservative treatment, and one fracture following remodeling of a malunited distal fracture of the humerus. In the treatment of the posttraumatic stiffness of the elbow, the arthrolysis and the arthroplasty are indicated in dependence on the existent (extrinsic or intrinsic) lesions and on their severity.

Treatment of Post-Traumatic Elbow Stiffness Using Soft Tissue Interposition Arthroplasty: A Retrospective Study in the Jordanian Population

Treatment of Post-Traumatic Elbow Stiffness Using Soft Tissue Interposition Arthroplasty: A Retrospective Study in the Jordanian Population

Intra-articular Olecranon Osteotomy and Adhesiolysis for Treatment of Post-traumatic Elbow Stiffness.

Introduction:Loss of motion is common in elbow trauma. Restoration of joint motion in post-traumatic stiff elbow can be a difficult, time consuming, and costly. We report a case of post-traumatic elbow stiffness treated with intra articular olecranon osteotomy and adhesiolysis.Case Presentation:A 30-year-old female, with right dominant upper extremity, presented 13 months after operated well aligned right intra articular distal humerus fracture with right elbow stiffness. She had a fixed flexion deformity of 20 degrees with flexion arc of 20–30 degrees and completely free supination and pronation. She was unable to perform the activities of daily living with affected right upper extremity. Intra-articular chevron olecranon osteotomy and adhesiolysis were done for the post-traumatic elbow stiffness. Immediate post-operative active and active assisted motion exercises of elbow joint were started. Indwelling infra clavicular catheter with continuous Ropivacaine infusion was kept for analgesia. At 6 month post-operative follow-up, she achieved 10–110 degree elbow flexion arc with completely free supination and pronation. She is able to perform the daily living activities with right upper extremity.Conclusion:Many different methods of treating post traumatic stiff elbow have been described, intra articular olecranon osteotomy helps in addressing intrinsic and extrinsic pathology with better results.

Arthroscopic Treatment of Posttraumatic Elbow Stiffness Due to Soft Tissue Problems.

ObjectivesTo evaluate the effectiveness of arthroscopic management of posttraumatic elbow stiffness due to soft tissue problems.MethodsA retrospective review of 30 consecutive arthroscopic elbow releases for posttraumatic stiff elbow from November 2011 to December 2019 was conducted. Stiff elbows with bony problems, such as heterotopic ossification, intraarticular nonunion or malunion, and cartilage lesions were excluded from this study. Contracture and adhesion of soft tissue around the elbow were identified. Surgical treatments included arthroscopic capsulectomy, ligaments and muscle release, and ulnar nerve release. The results were evaluated using the Mayo elbow performance score (MEPS) and range of motion of the elbow. Surgery‐related complications were assessed.ResultsPatients who underwent arthroscopic release were followed up for between 6 and 35 months, with a mean follow‐up time of 10.1 months. The postoperative elbow ROM was 123.2° ± 19°, which was significantly different compared to the preoperative value of 68° ± 32°. In addition, the MEPS score improved from 71.2 ± 10.3 preoperatively to 93.7 ± 6.6 at the final follow‐up, a mean improvement of 22.5 (range, 0–55; P < 0.05). Postoperative complications included five cases of prolonged drainage from the portal site, three transient nerve palsies, and one hematoma in the medial elbow.ConclusionWith full recognition by the surgeon of the pathologic changes of the soft tissue around the elbow, arthroscopic release is usually safe and effective for posttraumatic elbow stiffness without symptomatic bony problems.

Treatment methods for post-traumatic elbow stiffness caused by heterotopic ossification

Heterotopic ossification (HO) is a common complication of surgically treated elbow fractures that can inhibit range of motion and impair quality of life. Although there are many treatment methods for HO, there is a lack of consensus as to the best option. We hypothesized that contracture release combined with Botox injection would lead to improved functional outcome scores when compared with current treatment methods. A retrospective review was conducted of patients who presented to a single surgeon with HO secondary to elbow fracture between 2005 and 2018. A total of 59 patients were identified who met inclusion criteria. Data were classified into 3 groups: contracture release (control - CR), Botox injection with CR (Botox + CR), and radiation therapy with CR (CR + RT). Range of motion measurements were obtained, including flexion, extension, pronation, and supination. A total of 30 patients (30 of 59, 50.8%) received CR, 6 (6 of 59, 9.2%) were treated with CR + RT, and 23 (23 of 59, 40.0%) had CR + Botox. There was a significant difference between pre- and postoperative arc of motion for both CR + RT (P < .01) and CR + Botox (P < .01). In addition, there was a significant difference in pre- and postoperative extension for patients who received intraoperative Botoxinjections (P < .05). There was no significant difference between pre- and postoperative motion nor extension in the CR group. Intraoperative Botox injection with CR is an effective method in the treatment of post-traumatic elbow stiffness caused by HO.

Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation

There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Handscore, absolute and relative increase in flexion-extension ROM, and complication rates. Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P< .001). Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.

Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach.

Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period ( p < 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% ( p < 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° ( p < 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively ( p < 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively ( p < 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period ( p = 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness: Should We Really?

Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness: Should We Really?

Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness.

Evaluate the safety and efficacy of manipulation under anesthesia (MUA) for posttraumatic elbow stiffness. Retrospective, case series. Single institution; level 1 trauma center. Chart review of 45 patients over a 10-year period treated with MUA for posttraumatic elbow stiffness after elbow injuries treated both operatively and nonoperatively. None. Change in total flexion arc pre- to postmanipulation; time to manipulation; complications. Average time from most recent surgical procedure or date of injury to MUA was 115 days. Average premanipulation flexion arc was 57.9 degrees; average flexion arc at the final follow-up was 83.7 degrees. The improvement in elbow flexion arc of motion was statistically significant (P < 0.001). Post hoc analysis of the data revealed 2 distinct groups: 28 patients who underwent MUA within 3 months of their most recent surgical procedure (early manipulation), and 17 patients who underwent MUA after 3 months (late manipulation). Average improvement in elbow flexion arc in the early MUA group was 38.3 degrees (P < 0.001); improvement in the late MUA group was 3.1 degree. Comparison of improvement between the early and late MUA groups found a significant difference (P < 0.001) in mean flexion arc improvement from premanipulation to postmanipulation, favoring the early group. One patient had a complication directly attributable to MUA. Nineteen patients required additional procedures on the injured extremity after MUA. MUA is a safe and effective adjunct to improving motion in posttraumatic elbow stiffness when used within 3 months from the original injury or time of surgical fixation. After 3 months, MUA does not reliably increase elbow motion. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Outcome of Open Surgical Treatment of Posttraumatic Elbow Stiffness

The Outcome of Open Surgical Treatment of Posttraumatic Elbow Stiffness

Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow

Extensive loss of elbow flexion compromises the performance of daily activities. We examined the clinical outcomes of patients with post-traumatic extension contracture of the elbow treated with open arthrolysis and pie-crusting release of the triceps tendon. We retrospectively reviewed the records of 7 patients (5 men and 2 women; mean age, 35 years) who underwent open arthrolysis via a combined lateral and medial approach with pie-crusting release of the triceps tendon for the treatment of post-traumatic elbow stiffness. All the patients had heterotopic ossification that restricted elbow motion and underwent removal of the ossified tissue and capsular release. The triceps tendon was gradually stretched by making multiple stab incisions on the tendon by using a No. 11 surgical blade. The range of motion of the elbow was recorded both preoperatively and at the final postoperative follow-up. Elbow function was assessed with the Mayo Elbow Performance Score. The patients were followed up for a mean of 24 months. After treatment, significant improvement was noted in the total arc of motion (from 44° to 116°, P <.001), mean flexion (from 80° to 124°, P < .001), and mean extension (from 31° to 8°, P = .004). The mean Mayo Elbow Performance Score improved significantly from 59 points preoperatively to 92 points at the final evaluation. No major postoperative complications developed in any of the patients. Our findings indicate that open arthrolysis with pie-crusting release of the triceps tendon is an effective and safe treatment approach for post-traumatic extension contracture of the elbow.

Outcomes of arthroscopic arthrolysis for the post-traumatic elbow stiffness.

Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, surgical release is recommended. Increase in arthroscopy knowledge and skills, as well as technological advances in the passed decade of years, has made arthroscopic arthrolysis a safe and reliable treatment for patients with a post-traumatic elbow contracture. The aim of this study was to report on the clinical outcome and improvement of ROM in post-traumatic stiff elbow treated by arthroscopic arthrolysis. Between 2008 and 2012, 34 consecutive patients with post-traumatic stiffness were treated with arthroscopic arthrolysis. Active and passive elbow movement is encouraged the day after operation with the effective pain management. Mayo Elbow Performance Index (MEPI) and visual analogue scale were measured. At the final follow-up, the average arc of elbow motion increased from 48.6 ± 19.3 pre-operatively to 114.5 ± 25.7, with a mean improvement of 65.9°. The MEPI score improved from 68.2 ± 16.4 pre-operatively to 92.4 ± 21.6, with a mean improvement of 24.2 (p < 0.001). Results were good to excellent in 29 patients. Injuries are the most common cause of elbow stiffness requiring surgical release. The procedure of arthroscopic arthrolysis is a good option for the treatment of post-traumatic elbow stiffness as it restores normal elbow function. Early passive/active post-operative rehabilitation is very important.

Post-traumatic elbow rotational stiffness.

The elbow is an important but complex structure, with movement in both the sagittal plane in flexion and extension, as well as the rotational plane in forearm supination and pronation. Trauma is a common cause of elbow stiffness, which significantly hampers daily function. There are currently no gold-standard management guidelines for post-traumatic elbow stiffness, and most of the published literature focuses solely on the sagittal plane of motion. This is a retrospective case series reviewing all patients who underwent a surgical release for treatment of post-traumatic elbow stiffness during a 36-month period. Motion range and the shortened version of the Disabilities of the Arm, Shoulder and Hand scores were serially measured and analyzed. The results obtained showed that both the sagittal and rotational range of motion directly influenced upper limb function; however, the relationship between these two motion planes was weak, meaning that both sagittal and rotational motion in the elbow need be addressed individually. Post-traumatic elbow stiffness could be aptly managed by various surgical approaches, including arthroscopic-assisted procedures; these were all effective in increasing both the sagittal and rotational range of motion. More importantly, this gain in range translated to a statistically significant improvement in upper limb function. Management of elbow stiffness needs to be tackled in both the sagittal and rotational motion planes.

Preliminary clinical experience with hyaluronan anti-adhesion gel in arthroscopic arthrolysis for posttraumatic elbow stiffness.

BackgroundLoss of motion of the elbow joint is a common finding after elbow trauma. It has been shown that arthroscopic treatment leads to excellent restoration of elbow motion, although it is still a demanding procedure. The aim of our cohort study was to assess clinical outcomes following treatment of posttraumatic elbow stiffness using arthroscopic arthrolysis with or without the associated use of a hyaluronan anti-adhesion gel.Materials and methodsA cohort of 36 consecutive patients undergoing elbow arthroscopic arthrolysis were enrolled: 17 patients in the hyaluronan gel group and 19 in the control group. The patients underwent prospective control visits 30 and 75 days after surgery. Functional outcome was measured by the range of motion and the Liverpool elbow score (LES), whereas pain and quality of life were evaluated using the visual analogue scale and the SF-36 questionnaire, respectively.ResultsThe range of motion and the overall LES score increased over time in both groups. The mean increase over time was statistically significant (p < 0.001) in both groups and there was no difference between the groups. There was also no interaction between time and treatment. The percentage of patients who reported pain decreased significantly over time (p = 0.0419) in the hyaluronan-treated group (suggesting limited contractions and better comfort during rehabilitation), but not in the control group. The intensity of pain decreased significantly over time in both groups (p < 0.0001) without any significant difference between the groups. All the changes in patient quality of life as measured by the SF-36 questionnaire were similar for the two groups of patients. No adverse event or complication related to the application of hyaluronan gel occurred.ConclusionsOur preliminary clinical experience showed promising results upon the use of hyaluronan gel, considering that it significantly reduced pain in the short term, facilitating a more comfortable rehabilitation. These findings should be confirmed by larger studies.

Surgical Release for Posttraumatic Loss of Elbow Flexion

Several surgical approaches have been suggested for the treatment of posttraumatic elbow stiffness; however, the optimal approach to elbows with considerable loss of flexion has not been well described. We investigated the pathologic lesions causing posttraumatic loss of elbow flexion and analyzed the results of surgical release. Forty-two patients with <100° of elbow flexion due to an extrinsic contracture following trauma underwent surgical release at a median of ten months after injury. To achieve maximum flexion, release of the posterior band of the medial collateral ligament was mandatory in all patients, and only four patients required additional anterior procedures. The ulnar nerve was transposed anteriorly in forty patients, including three who had had a previous transposition. To evaluate the results, we compared preoperative and postoperative elbow motion, Mayo Elbow Performance Index (MEPI) scores, and radiographs. Intraoperatively, heterotopic ossification was observed in forty patients. It was located predominantly in the posteromedial aspect of the capsule. Heterotopic bone was more commonly found during surgery than it was identified preoperatively on radiographs. Mean flexion increased significantly from 89° preoperatively to 124° (range, 90° to 140°) at a mean of thirty-nine months postoperatively. The mean size of the flexion contracture decreased from 34° preoperatively to 9° (range, 0° to 30°) postoperatively. Overall, ≥120° of final flexion and a total arc of ≥100° were regained by 88% of the patients. The mean MEPI score improved significantly from 73 points preoperatively to 94 points (range, 72 to 100 points) postoperatively, with the result rated as excellent in thirty-two patients, good in eight, and fair in two. Two patients had clinical recurrence of heterotopic ossification associated with a failure to obtain an increase in flexion. This study demonstrates that posttraumatic heterotopic ossification, particularly in the posteromedial aspect of the capsule, is closely associated with loss of elbow flexion. Satisfactory restoration of elbow flexion can be obtained in the majority of patients by surgical release of the posterior band of the medial collateral ligament and excision of heterotopic bone.

Arthrolysis and a hinged external fixator for posttraumatic elbow stiffness

Objective To study the clinic results of arthrulysis and a hinged external fixator for treatment of posttraumatic elbow stiffness. Methods From February 2006 to April 2008,we treated 16patients,10 males and 6 females with an average age of 30.5 years(16 to 42 years),with open arthrolysis and a hinged external fixator.Flexion deformity was observed in 11 patients.The mean interval between trauma and arthrolysis was 13 months.After radiological examination,the lateral Kocher incision was used in 11 patients.the medial incision in 4 and the medial and lateral incision in one.The operation was to eliminate all the factors affecting the joint movement and to restore the range of motion(ROM)of the elbow.Early rehabilitation was encouraged after a hinged external fixator Was applied. Results After an average followup peried of 16 months,the mean ROM improved from preoperative 34°±26°to postoperative 92°±14° (P<0.05).The Mayo elbow performance score(MEPS)improved from preoperative 42 ±11 to postoperatire 84±16(t=4.351,P<0.05).No such complications as iatrogenic elbow instability and incision infection were discovered. Conclusion Arthrolysis and a hinged external fixator can keep stability of the elbow and its specific position,allowing early rehabilitation to promote functional recovery of the elbow. Key words: Elbow ioint; wounds and injuries; External fixator; Stiffness; Arthrolysis

Surgical Treatment of Post-traumatic Elbow Stiffness

Purpose : We analyzed the clinical results of surgical treatment in patients with post-traumatic stiff elbow. Materials and Methods : We performed surgical release in 22 elbows with posttraumatic stiffness of extraarticular origin. The average preoperative arc was 48.3 degrees, with an average flexion contracture of 39.5 degrees and an average further flexion of 87.2 degrees. Depending on their radiographic findings, cases were divided on the basis of whether ectopic ossification was present (16 cases) or not (6 cases); and as to whether the articular surface was involved (11 cases) or not (11 cases). The postoperative final arc and ratio of desired gain were compared between the groups. Results : The average final arc was 108.9 degrees in the ectopic ossification group and 85.7 degrees in the non-ectopic ossification group, and showed a significantly higher arc in the ectopic ossification group. The ratios of desired gain were 89.3% and 62.6%, respectively, being significantly higher in the ectopic ossification group. In terms of articular surface involvement, no significant difference was observed between the two groups. Conclusion : When performing operative treatment for post-traumatic stiff elbow, assessment of the cause plays an important role. In case of ectopic ossification, satisfactory results can be expected with operative treatment after the ectopic bone has matured.