title: Stability of severely stiff elbows after complete open release: treatment by ligament repair with suture anchors and hinged external fixator.
abstract: BACKGROUND
  Instability is a crucial issue in severe post-traumatic elbow stiffness during complete-release surgery. This study aimed to evaluate the efficacy of ligament repair using a suture anchor in the operative treatment of severely stiff elbows for which a hinged external fixator was indicated.
  
  
  METHODS
  We retrospectively reviewed 46 cases of severely stiff elbows (flexion arc <60°) undergoing open release. During the operation, all 46 elbows were noted to have instability. Suture anchors were applied to restore the ligament if it was impossible to repair the ligament directly, and a hinged external fixator was simultaneously applied to protect the vulnerable ligament and facilitate rehabilitation. No allograft or autograft was used in any of our cases. The stability, arc of motion, Mayo Elbow Performance Score, ulnar nerve symptoms, and radiographs were evaluated.
  
  
  RESULTS
  At a mean follow-up of 24.3 months, the postoperative Mayo Elbow Performance Score was 91 points, as compared with 63 points preoperatively. The mean flexion arc improved from 25° to 126°. Three patients presented with moderate elbow instability when the hinged external fixator was removed; however, all of them regained stability by the last follow-up. Furthermore, 7 cases of new-onset nerve palsy were noted; however, all of them resolved with conservative management. None of the patients required secondary surgery for any reason.
  
  
  CONCLUSIONS
  Repair of an avulsed collateral ligament with suture anchors and hinged external fixation was effective in restoring functional mobility in patients with severe post-traumatic elbow stiffness after complete release. This could be an option for treating ankylosed, severely or very severely stiff elbows.
authors.affiliation: Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Shi-chao
authors.initials: SC
authors.lastname: Jiang
authors.affiliation: Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Hong-jiang
authors.initials: HJ
authors.lastname: Ruan
authors.affiliation: Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. Electronic address: fancunyi888@hotmail.com.
authors.forename: Cun-yi
authors.initials: CY
authors.lastname: Fan
mesh_terms: D000328:Adult; D000844:Ankylosis / Q000209:etiology / Q000601:surgery*; D001134:Arm Injuries / Q000150:complications / Q000601:surgery; D017885:Collateral Ligaments / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D016267:External Fixators; D005260:Female; D006801:Humans; D057913:Joint Capsule Release / Q000009:adverse effects; D007593:Joint Instability / Q000209:etiology / Q000534:rehabilitation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D053441:Suture Anchors; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Elbow stiffness; anchor; hinged external fixator; instability; ligament; release; severe