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Column procedure shows efficacy for treating post-traumatic elbow stiffness
Surgery significantly improved range of motion to 104° from 69° preoperatively.
Treating patients who have post-traumatic elbow stiffness using a column procedure can yield good functional outcomes, according to 2-year results of a study by researchers in the Netherlands.
However, "Postoperative rehabilitation is important, especially during the first 3 months after surgery," the study authors noted.
Udo Gundlach, MD, and colleague Denise Eygendaal, MD, evaluated outcomes for 21 patients treated for post-traumatic elbow contractures at an average age of 40 years. In all cases, patients had not adequately responded to prior nonoperative treatments.
Surgery was only performed in patients who had either a flexion contracture of at least 30° or a range of motion (ROM) of less than 100°. Also, patients had to have an intact or healed articular surface, according to the study, published in Acta Orthopaedica.
The surgical technique involved a supracondylar incision made on the humeral ridge, followed by release of the extensor carpi radialis longus.
"Using an anterior approach, the anterior capsule is released and the coronoid process and coronoid fossa are assessed and debrided. The same incision is used for a posterior capsular release," the authors reported.
"The triceps is elevated from the posterior aspect of the humerus, the posterior aspect of the capsule is released and the olecranona fossa is cleaned of soft tissue," they wrote.
Postoperatively, continuous passive motion was initiated within 2 hours of surgery for at least 12 hours a day for a total of 48 hours. Patients also wore a dynamic extension splint at night for 3 months, according to the study.
The researchers found that surgery produced a significant improvement in ROM, from 69° preoperatively to 104° at 3 months follow-up (P < .05). The mean elbow function assessment (EFA) score also significantly improved from 74 points preoperatively to 91 points, according to the study.
"No significant differences were found between the VAS [Visual Analog Scale] scores or in the ROM for pro- and supination. The postoperative ROM and EFA scores at 3, 12, and 24 months were similar," the authors wrote.
No patients experienced vascular or neurological complications. However, two patients showed radiographic evidence of small periarticular ossifications in the anterior capsule 1 year postoperatively, which had not been noted on preoperative radiographs, they noted.
For more information:
- Gundlach U, Eygendaal D. Surgical treatment of posttraumatic stiffness of the elbow: 2-year outcome in 21 patients after a column procedure. Acta Orthop. 2008;79:74-77.