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Gains in elbow range of motion seen with contracture release
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 Amirhesam Ehsan |
Open elbow contracture release allowed most patients with post-traumatic elbow arthrofibosis to achieve at least 100º functional elbow arc of motion, according to a large study of cases performed by a single surgeon.
“Our early open elbow contracture release was an effective means of restoring functional elbow range of motion with a fairly low complication rate,” Amirhesam Ehsan, MD, said as he presented results of the retrospective chart review at the 2011 Annual Meeting of the American Society for Surgery of the Hand. “Patients with recurrent [heterotopic ossification] HO formation and elbow arthrofibrosis actually respond well to repeat surgical release. In this series, routine external neurolysis of the ulnar nerve with submuscular transposition lead to successful rates of ulnar nerve symptom resolution with no new nerve injuries.”
To determine the efficacy of open elbow release in restoring function, Ehsan and colleagues performed a review of 177 patients with post-traumatic elbow arthrofibrosis who underwent the procedure. Among patients excluded from the study were those with infection, burns and isolated proximal radioulnar exostosis excisions. The study group had a mean age of 45 years and most were men. The investigators found preoperative radiographic evidence of HO in 68 patients.
During the procedure, the surgeon performed a complete capsulectomy, HO excision, ulnar nerve neurolysis with submuscluar anterior transposition and removed symptomatic hardware. All patients underwent continous passive motion postoperatively and were followed for a mean of 12 months.
The investigators discovered the mean flexion-extension arc improved from 51º to 109º at 12-month follow-up. “Overall, 69% of our patients were able to achieve a functional arc of elbow motion greater than or equal to 100º,” Ehsan said.
Six patients developed recurrent HO and underwent a secondary excision and subsequently gained 100º elbow arc of motion. In addition, one patient had recurrent arthrofibrosis without HO and underwent a manipulation at 6 weeks.
Ehsan also noted eight complications, including five infections, one radial head implant loosening, one proximal ulnar fracture that occured at 7 months postoperatively by way of a previous screw hole and one case of a postoperative hematoma.
Reference:
- Ehsan A, Huang JI, Lyons, Hanel DP. Surgical management of post-traumatic elbow arthrofibrosis. Paper #57. Presented at the 2011 Annual Meeting of the American Society for Surgery of the Hand. Sept. 8-10. Las Vegas.
This is a nice presentation and manuscript. I actually think that this could be an important paper. It is unusual to have such a large series by one surgeon and unusual that the one surgeon did the same thing in all the patients.
— Mark E. Baratz, MD
Session moderator
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