The use of combined lateral and medial releases in the treatment of post-traumatic contracture of the elbow

Clinic of Orthopaedics and Traumatology, Tatvan Military Hospital, Bitlis, Turkey.
International Orthopaedics (Impact Factor: 2.11). 11/2007; 31(5):635-8. DOI: 10.1007/s00264-006-0252-2
Source: PubMed


Elbow stiffness is a common disorder, which restricts daily activities. Between 30 degrees and 130 degrees of elbow movement is usually enough to perform most daily activities. However, a 10 degrees to 15 degrees loss of elbow extension may be a problem when the patient is an athlete. From 1996 to 2004, 20 elbows of 20 patients (who were available for follow-up examination) were treated by lateral and medial release at Kocaeli University, for post-traumatic elbow contracture. Preoperative and the postoperative 12-month follow-up measurements were performed. The mean preoperative arc of motion was 35 degrees and this value improved to 86.2 degrees . The maximum improvement at the arc of motion was 105 degrees . In an effort to understand the pathophysiology of the condition, surgical approaches may be used safely. The purpose of this study was to assess the functional outcome of the elbow joint after using a combination of lateral and medial approaches to treat elbow stiffness.

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    • "The average extension and AOM were inferior to the intra-operative values; however, flexion remained stable. A postoperative decrease in the ROM was mentioned in the literature [7–20]; however, significant differences have rarely been reported. Nobuta et al. reported a similar decrease of postoperative extension and lack of significant changes of flexion [12]. "
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    International Orthopaedics 12/2013; 38(3). DOI:10.1007/s00264-013-2172-2 · 2.11 Impact Factor
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    ABSTRACT: Heterotopic ossification which may develop following elbow injuries or elbow surgery may result in complete loss of elbow functions. We evaluated the results of surgical treatment for ankylosis of the elbow due to posttraumatic heterotopic ossification. The study included seven patients (6 males, 1 female; mean age 36 years; range 23 to 55 years) who developed heterotopic ossification and ankylosis of the elbow joint following surgical treatment of high-energy fractures in the circumference of the elbow. Two patients had comminuted olecranon fractures and elbow luxation, and five patients had comminuted intra-articular distal humeral fractures. Three patients had open fractures. Involvement was in the right elbow in two patients, and in the left elbow in five patients. One patient was monitored and treated in the intensive care unit for head trauma for 22 days. Initially, six patients were treated with plate osteosynthesis and one patient with tension band wiring. Foci of heterotopic ossification were detected on the radiographs taken after a mean of 24 days (range 20 to 32 days) following surgical treatment of fractures. The patients were followed-up with conventional radiography and scintigraphy for a mean of 11 months (range 7 to 15 months) before surgical treatment, during which functional loss in elbow joint movements deteriorated and ankylosis developed. All the patients had Hastings type IIIC ankylosis and poor Mayo elbow performance scores (mean score 50.7). A posterior incision was used in three patients, and a double-column incision was used in four patients. At surgery, the ulnar nerve and the lateral and medial collateral ligaments were preserved, and a posterolateral capsular release, removal of heterotopic ossification, purging of the olecranon fossa, and resection of the tip of the olecranon were performed. After completion of capsular release, cartilage pathologies were evaluated. Four patients were found to have no definite cartilage damage, whereas in three patients the joint cartilage was seriously damaged. At final controls, the patients were assessed with the Mayo elbow performance score. The mean follow-up period was 23.4 months (range 10 to 36 months). In all cases, the range of motion and stability of the elbow joint were controlled and were found to be complete and stable at the end of the operation. At final controls, the Mayo elbow performance scores were good in three patients, moderate in one patient, and poor in three patients. All the patients with a poor elbow score had severe joint cartilage damage intraoperatively. Patients who develop heterotopic ossification and ankylosis of the elbow following trauma or elbow surgery may benefit from removal of heterotopic ossification foci and elbow relaxation procedures provided that there is not severe damage to the articular cartilage.
    acta orthopaedica et traumatologica turcica 05/2010; 44(3):206-11. DOI:10.3944/AOTT.2010.2441 · 0.61 Impact Factor
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