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

Abstract

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.

Keywords: contracture; elbow joint; joint capsule release; post-traumatic stiffness; treatment outcome.

Conflict of interest statement

Conflict of Interests The authors have none to declare.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).

Figures

Fig. 1

Image of the surgical technique. (A) Wide posterior approach; (B) medial dissection and ulnar nerve location; (C) lateral dissection and visualization of the radio head and capitulum; (D) closing and final aspect with vacuum drain placement.

Fig. 2

Case illustrating the (A) continuous passive motion(CPM)device; (B) static orthosis for extension gain; and (C) dynamic orthosis for flexion gain.

Fig. 3

Results of flexion-extension and pronosupination range of motion during follow-up.

Fig. 4

Results of the absolute and relative range of motion gain for flexion-extension during follow-up.

Fig. 5

Results of the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) functional scales during follow-up.

Fig. 1

Imagem da técnica cirúrgica. (A) via posterior ampla; (B) dissecção medial e localização do nervo ulnar; (C) dissecção lateral e visualização da cabeça do rádio e capítulo; (D) fechamento e aspecto final com colocação de dreno a vácuo.

Fig. 2

Caso ilustrando o (A) aparelho de movimento passivo contínuo (MPC); (B) a órtese estática para ganho da extensão; e (C) a órtese dinâmica para ganho da flexão.

Fig. 3

Resultados da amplitude de movimento de flexoextensão e pronossupinação ao longo do seguimento.

Fig. 4

Resultados do ganho da amplitude de movimento absoluta e relativa de flexoextensão ao longo do seguimento.

Fig. 5

Resultados das escalas funcionais Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) ao longo do seguimento.