Surgical Release for Posttraumatic Loss of Elbow Flexion.

Abstract

We describe a surgical release for patients who have a lack of elbow flexion limiting the ability to perform activities of daily living after trauma. Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels. Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa. Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved. Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion. Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers. Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles. Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months. Forty-two patients with <100° of elbow flexion as an extrinsic contracture following trauma had a surgical release of the elbow at a median of ten months postinjury. IndicationsContraindicationsPitfalls & Challenges.