American Research Journal of Orthopedics and Traumatology

Background: Posttraumatic stiff elbow is a frequent and disabling complication and causes difficulty in placement of hand in space and hence limits the functional capacity. It poses challenges for management. The initial management should be nonoperative and surgical treatment is indicated when conservative measures for a reasonable period fail to achieve the functional range of motion. The aim of this study was to assess the outcome of open arthrolysis of posttraumatic elbow stiffness.
Patients and Methods: A prospective study was conducted at our institution, between 2013 and 2016, on open surgical release of posttraumatic elbow stiffness in 16 elbows of 16 patients (who were available for follow-up examination). The mean age of the patients was 22±4.2 years (range: 12-36 yrs). The mean time interval between injury and surgical release was 8.3±2 months (range: 3 -12 months). The surgical approach was: lateral (n=10), medial (n=3) and combined lateral and medial (n=3). All patients underwent extensive rehabilitation, starting immediately after the procedure.
Results: The mean follow-up period was 8.5±2 months (range: 7-13months), The preoperative total flexion/extension arc improved from a mean of 40˚± 10.5 to 105˚± 21.5 (60 to 135) at the final follow-up, with a mean gain of 65˚± 4. The mean preoperative Mayo Clinic Elbow Performance Score of 60 ±17.5 points (20-70), improved at the final follow-up to 85 ± 8.8 points (70 to 100), with a mean gain of 25 ± 4.5 points. The results were excellent in six elbows, good in seven, fair in two and poor in one. Therefore, a satisfactory functional outcome was achieved in 81.25% of cases. Superficial infection occurred in one patient (that cured on antibiotic and local care) but, no deep infection. One case of preoperative ulnar nerve deficit recovered finally after anterior transposition. Two patients had postoperative transient paresthesia of ulnar nerve, but without a measurable motor or sensory deficit. Recurrence of stiffness occurred in one patient (6.25%), who was a 12 years old uncooperative patient.
Conclusion: The open release of posttraumatic elbow stiffness provides a useful gain in range of motion and marked improvement of elbow function, especially in motivated co-operative patients.