Operative Treatment of Elbow Stiffness.

Abstract

Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness. Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions. Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used. Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule. Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule. When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator. Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants. Close the muscle intervals and skin. The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches. A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°. IndicationsContraindicationsPitfalls & Challenges.