Surgical release of elbow stiffness after internal fixation of intercondylar fracture of the distal humerus.
BACKGROUND
Loss of motion is common after intercondylar fracture of the distal humerus despite proper management. The purpose of the current study was to report the results of contracture release for stiffness that developed after open reduction and internal fixation (ORIF) of distal humeral intercondylar fractures.


METHODS
Twenty-four consecutive patients with a stiff elbow after ORIF of intercondylar fractures (20 AO type C2 and 4 type C3 fractures) were managed with contracture release at a median of 13 months. The surgical indication was total arc of motion of less than 100° despite physical therapy for more than 6 months. Plates and screws for ORIF were removed concomitantly in 16 patients. Each patient was evaluated by final arc of motion and Mayo Elbow Performance Score (MEPS).


RESULTS
The main lesions causing stiffness were heterotopic ossification or excessive callus in 13 patients and capsular fibrosis in 11. The mean total range of motion (ROM) was improved from 60.2° preoperatively to 104.8° postoperatively. At the final follow-up, 17 of the 24 elbows (71.8%) obtained a total ROM of more than 100°. The mean MEPS improved from 69 points preoperatively to 87 points at the final follow-up (P < .05). Refracture occurred during ROM exercise in 4 patients who had undergone concomitant implant removal during the contracture release.


CONCLUSIONS
Surgical release of a stiff elbow that develops after ORIF of intercondylar fractures can result in satisfactory restoration of ROM in most patients. However, potential risk of refracture after release should be considered when implants are concomitantly removed.
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
Kyoung Hwan
KH
Koh
Tae Kang
TK
Lim
Hyun Il
HI
Lee
Min Jong
MJ
Park
D000328:Adult; D002146:Bony Callus / Q000473:pathology / Q000601:surgery; D003286:Contracture / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000534:rehabilitation / Q000601:surgery*; D057913:Joint Capsule Release; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000601:surgery; D016059:Range of Motion, Articular; D055815:Young Adult