title: Arthrolysis and delayed internal fixation combined with hinged external fixation for elbow stiffness associated with malunion or nonunion of capitellum fracture.
abstract: BACKGROUND
  This study assessed outcomes after treatment of patients with capitellum fracture diagnosed >4 weeks after the trauma (delayed) who presented with stiff elbow.
  
  
  METHODS
  We reviewed 7 patients with stiff elbows after delayed diagnosis of capitellum fractures between February 2007 and February 2012. They were treated with arthrolysis by twin incisions, late open reduction and internal fixation, and a hinged external fixator. According to the Bryan-Morrey-McKee classification, 3 patients had type I capitellum fractures and 4 patients had type IV.
  
  
  RESULTS
  Mean follow-up was 28 months (range, 24-38 months). The mean delay from the initial trauma was 3.7 months. The flexion arc improved from a preoperative mean of 24° to a postoperative mean of 122°. The Mayo Elbow Performance Score increased from a mean of 56 points to 93 points. Anatomic fracture union occurred in all cases, and there was no secondary displacement.
  
  
  CONCLUSIONS
  Arthrolysis, late internal fixation, and use of a hinged external fixator can solve problems associated with stiff elbow after delayed diagnosis of capitellum fracture. Combined use of these techniques may be a safe and effective treatment option.
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shi-Yang
authors.initials: SY
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Hong-Jiang
authors.initials: HJ
authors.lastname: Ruan
authors.affiliation: Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Jun-Jian
authors.initials: JJ
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Xu-Jun
authors.initials: XJ
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Yu-Lin
authors.initials: YL
authors.lastname: Zhan
authors.affiliation: Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. Electronic address: fancunyi888@hotmail.com.
authors.forename: Cun-Yi
authors.initials: CY
authors.lastname: Fan
mesh_terms: D000293:Adolescent; D000328:Adult; D000844:Ankylosis / Q000209:etiology / Q000601:surgery*; D057210:Delayed Diagnosis; D004551:Elbow Joint / Q000601:surgery; D016267:External Fixators; D005260:Female; D005593:Fracture Fixation, Internal; D017759:Fractures, Malunited / Q000150:complications / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D061665:Time-to-Treatment; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Stiff elbow; arthrolysis; capitellum fracture; delayed fracture; hinged external fixation; internal fixation