THE STIFF ELBOW - HOW I DO IT

Contracture of the elbow is a common complication of fractures, disloc ations, burns, etc., around the elbow. The stiff or contracted elbow i s defined as an elbow with a reduction in extension greater than 30 de grees, and/or a flexion less than 120 degrees. Although supination and pronation are often reduced as well, this will not be considered furt her as contracture of the elbow is not related to forearm rotation. St iffness of the elbow impairs hand function, because this is highly dep endent on elbow extension and flexion and forearm rotation. A 50% redu ction of elbow motion can reduce the upper extremity function by almos t 80%. Surgery of the posttraumatic stiff elbow is a challenging and d emanding procedure. During recent years a more aggressive approach to the treatment of chronic contractures around the elbow joint in combin ation with more specific surgical techniques and an advanced postopera tive rehabilitation have improved the final outcome. The purpose of my article is to define a reasonable and specific approach for the clini cian in the surgical management of the posttraumatic stiff elbow, base d on a review of the literature and my personal experience.