title: Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow.
abstract: BACKGROUND
  Extensive loss of elbow flexion compromises the performance of daily activities. We examined the clinical outcomes of patients with post-traumatic extension contracture of the elbow treated with open arthrolysis and pie-crusting release of the triceps tendon.
  
  
  METHODS
  We retrospectively reviewed the records of 7 patients (5 men and 2 women; mean age, 35 years) who underwent open arthrolysis via a combined lateral and medial approach with pie-crusting release of the triceps tendon for the treatment of post-traumatic elbow stiffness. All the patients had heterotopic ossification that restricted elbow motion and underwent removal of the ossified tissue and capsular release. The triceps tendon was gradually stretched by making multiple stab incisions on the tendon by using a No. 11 surgical blade. The range of motion of the elbow was recorded both preoperatively and at the final postoperative follow-up. Elbow function was assessed with the Mayo Elbow Performance Score.
  
  
  RESULTS
  The patients were followed up for a mean of 24 months. After treatment, significant improvement was noted in the total arc of motion (from 44° to 116°, P <.001), mean flexion (from 80° to 124°, P < .001), and mean extension (from 31° to 8°, P = .004). The mean Mayo Elbow Performance Score improved significantly from 59 points preoperatively to 92 points at the final evaluation. No major postoperative complications developed in any of the patients.
  
  
  CONCLUSIONS
  Our findings indicate that open arthrolysis with pie-crusting release of the triceps tendon is an effective and safe treatment approach for post-traumatic extension contracture of the elbow.
authors.affiliation: Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China.
authors.forename: Yu-lin
authors.initials: YL
authors.lastname: Zhan
authors.affiliation: Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shi-yang
authors.initials: SY
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Xian-you
authors.initials: XY
authors.lastname: Zheng
authors.affiliation: Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China.
authors.forename: Shen
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Shanghai Sixth People's Hospital East Branch, Shanghai, China; Department of Orthopaedics, Shanghai Jiaotong 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: D000328:Adult; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D004551:Elbow Joint / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057913:Joint Capsule Release / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D009999:Ossification, Heterotopic / Q000209:etiology / Q000601:surgery; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013710:Tendons / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Pie crusting; arthrolysis; elbow stiffness; extension contracture; tendon lengthening; triceps