[Open arthrolysis of elbow stiffness].
According to the literature approximately 5% of all elbow injuries result in elbow stiffness. Following pathomorphological aspects elbow stiffness can be classified into intrinsic (intra-articular) and extrinsic (extra-articular) types. Mixed forms are common. Patient evaluation should include age, degree of stiffness, predisposition and anamnesis of professional and leisure time. Basic diagnostics for planning surgical treatment routinely include clinical evaluation, x-rays and computed tomography. Before indications for open arthrolysis of the elbow are given conservative treatment of more than 3 months should be performed. General indications for surgical treatment are pain, limitations in the range of motion and functional deficits. Contraindications are infections and severe general or psychological comorbidities. The optimal results of open elbow arthrolysis are a pain-free situation and freedom of movement of the elbow with retained strength and stability of the joint. Surgical approaches should be adapted to the individual joint pathology and should use previous approaches to avoid further soft tissue and/or joint trauma. For open arthrolysis of the elbow different approaches can be performed; however, the radial (lateral) combined with the ulnar (medial) approach is most common. Postsurgical procedures include physiotherapy, physical therapy, lymph drainage, bedding splints and continuous passive motion therapy. The results after open arthrolysis of the elbow are mainly influenced by the correct indications and patient selection. According to the literature the range of motion in flexion/extension improved on average 47° and functional scores increased significantly. In addition to general surgical complications the main complication after surgery was a deterioration of the range of motion. The total complication rate ranged from 0 to 30%. However, open arthrolysis of the elbow is a technically simple, safe and on average less complicated surgical procedure, which shows good results, if the indications are correct.
Abteilung für Unfall- und Wiederherstellungschirurgie, Chirurgische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18057, Rostock, Deutschland. benjamin.ulmar@med.uni-rostock.de
B
B
Ulmar
A
A
Eschler
T
T
Mittlmeier
D000465:Algorithms; D000844:Ankylosis / Q000175:diagnosis* / Q000601:surgery*; D003286:Contracture / Q000175:diagnosis* / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D006801:Humans; D010027:Osteotomy / Q000379:methods*