Elbow arthrolysis in severely stiff elbows

This study involves the results of open elbow arthrolysis performed on a series of patients having fixed joint contracture.

Eighteen patients were treated with open arthrolysis. Eleven patients had very severely stiff elbows (flexion arc less than 30°), five patients had severely stiff elbows (31°–60°) and two patients had moderately stiff elbows (60°–90°). Fixed flexion deformity was observed in nine patients preoperatively.The mean interval between the trauma and arthrolysis was 14.8 months. The mean age was 27 years. After radiological examination, lateral kocher incision was used on 13 patients, medial and lateral incision on 3 patients, transolecranon approach on 1 patient and anterior and posterior approach on 1 patient. External fixator was applied on four patients. Fasia lata interposition was performed in three patients. Additional procedures were as follows, bone fixation in five patients, bone grafting in two patients, nerve grafting in one patient, subcutaneous ulnar nerve transposition in three patients. The average follow-up time was 47 months.

At the final evaluation, the mean extension deficit had improved from 55° to 32°. The mean end flexion increased from 81° to 124° postoperatively. The flexion arc of three patients in whom heterotopic ossification was excised had increased to 65°. Infection was diagnosed in two patients (11%).

The importance of this study is that the patients have fixed deformities and a long follow-up time. Severely stiff elbow is one of the main indications of open arthrolysis in the patients without muscle atrophy. We suggest sequential arthrolysis as an effective way to obtain good range of motion especially in severe stiff elbows as well as to maintain the ligamantous stability of the elbow joint.