Open elbow contracture release: postoperative management with and without continuous passive motion.
OBJECTIVE
Surgical contracture release can restore motion to stiff elbows. Some authors suggest that use of continuous passive motion (CPM) in postoperative management can increase ultimate mobility. This study tests the null hypothesis that there is no difference in the arc of flexion and extension between patients who used CPM and those who did not use CPM after open elbow contracture release.


METHODS
Sixteen patients who had an arc of flexion and extension of less than 80 degrees and used CPM after open contracture release were matched based on age, gender, diagnosis, preoperative arc of flexion and extension, and radiographic appearance (joint congruity, heterotopic bone, and arthritis) to 16 control patients who did not use CPM. Stiffness was of posttraumatic origin in 24 patients, related to primary osteoarthrosis in 4 patients, and related to heterotopic ossification after central nervous system injury or burns in 4 patients. The preoperative arc of flexion and extension averaged 38 degrees in the CPM cohort and 42 degrees in the no-CPM cohort.


RESULTS
Subsequent surgeries included procedures to address residual stiffness in 1 patient in the CPM cohort and in 3 patients in the no-CPM cohort. At an average 6 months of follow-up, there was no difference in improvement in the arc of flexion and extension (58 degrees vs 61 degrees ) between the CPM and no-CPM cohorts. At the final evaluation, the improvement in arc of flexion and extension (59 degrees in both cohorts) and the final arc of flexion and extension (96 degrees vs 101 degrees ) were comparable between cohorts.


CONCLUSIONS
These matched retrospective data do not demonstrate a benefit of CPM in the postoperative management of elbow contracture release.
Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA 02114, USA.
Anneluuk L C
AL
Lindenhovius
Koen
K
van de Luijtgaarden
David
D
Ring
Jesse
J
Jupiter
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D004550:Elbow / Q000503:physiopathology / Q000601:surgery*; D004551:Elbow Joint / Q000502:physiology; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D055815:Young Adult