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Surgical Management of the Posttraumatic Stiff Elbow

A Step-Wise Algorithm for Open Osteocapsular Release

Gauger, Erich M., MD*; Rhee, Peter C., DO, MS

Techniques in Hand & Upper Extremity Surgery: December 2018 - Volume 22 - Issue 4 - p 127–133
doi: 10.1097/BTH.0000000000000206
Technique

Posttraumatic elbow stiffness is common with the primary indication for contracture release being limited motion that affects functional activities which has not adequately improved after intensive therapy and rehabilitation. Preoperative evaluation focuses on the history of previous nonoperative and/or operative treatment, physical exam with particular attention paid to the status of the ulnar nerve, and imaging consisting of radiographs and computed tomography. There are multiple intrinsic and extrinsic causes of posttraumatic contracture. In general, limitation of motion in one direction can be attributed to a mechanical block and/or opposing contracture or tightness. Open elbow contracture release has been shown to improve motion, patient health status and disability scores with the specific surgical approach based upon the contracture pathology and surgeon preference. A step-wise algorithm is presented for open osteocapsular release. An anterior and posterior release is performed first through a lateral approach with the addition of a medial approach if ulnar nerve dysfunction exists or inadequate release has been obtained from the lateral approach. A previous posterior incision can be utilized by raising full thickness flaps. After release, gentle manipulation is performed and intraoperative stability is assessed with stress testing under fluoroscopy. Postoperatively, pain is managed with an in-dwelling nerve catheter and rehabilitation commences immediately. Significant improvement in range of motion can be expected with adequate surgical release and postoperative rehabilitation.

*Division of Hand Surgery, Vanderbilt University Medical Center, Nashville, TN

Division of Hand Surgery, Mayo Clinic, Rochester, MN

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Peter Rhee, DO, MS, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: rhee.peter@mayo.edu.

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