Mini Open Technique for Elbow Contracture Release
Loukia K. Papatheodorou, MD; Dean G. Sotereanos, MD
UPMC, University of Pittsburgh, Pittsburgh, PA
Elbow stiffness, posttraumatic or degenerative, is a difficult and challenging problem. Several surgical techniques have been suggested for the treatment of elbow contracture, however, the optimal approach has not been well described. The purpose of this retrospective study was to report the outcomes of a lateral column approach combined with a a minimal posterior triceps splitting approach for elbow contracture release.
Material & Methods
Fourty-three elbow contractures were included in the study, twenty-six were posttraumatic and seventeen were degenerative. There were nine women and thirty-four men with a mean age of 38 years (range, 19-58 years) at the time of the surgery. All elbow releases were performed through a lateral column approach combined with a minimal posterior approach. Through a limited Kocher approach the anterior capsule was released and any coronoid osteophyte and loose bodies were removed. Then through a separate mini posterior triceps splitting incision the posterior capsule was released and any posterior olecranon osteophyte and loose bodies were removed. After anterior and posterior capsular releases had been completed, a gentle elbow manipulation using a short level arm was used to maximize motion. At the end of the procedure, a well-padded, long-arm posterior splint was applied with the forearm in neutral and the elbow in 20° of flexion. The splint was removed 1 week later, physical therapy was initiated for active range of motion and a removable hinged elbow splint was used which provides passive stretching in flexion and extension.
Mean follow-up was 41 months (range 24-58 months). There was a significant improvement in mean pain levels from 7.7 preoperatively to 0.4 postoperatively. The total arc of elbow motion increased significantly from 51o preoperatively to 110o postoperatively with an improvement of 59o. The patients maintained 94% of the motion that was achieved intraoperatively at the final follow-up. No patient lost motion. Persistent pain with extreme extension was observed in two patients. The remaining patients were symptom free. No patient suffered triceps weakness of or instability of the elbow. The Mayo Elbow Performance score improved significantly from 43 preoperatively to 91 postoperatively.
Open elbow contracture release using a combined lateral and mini open posterior triceps splitting approach is a safe and effective technique for the surgical treatment of elbow contractures caused by osteoarthritis and post-trauma. This approach provides excellent visualization and addresses pathology in both the anterior and posterior compartments of the elbow joint in contractures.
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