THE COLUMN PROCEDURE - A LIMITED LATERAL APPROACH FOR EXTRINSIC CONTRACTURE OF THE ELBOW

Thirty-eight elbows (thirty-seven patients) with an extrinsic contract ure were treated operatively with a limited lateral approach to the an terior and posterior aspects of the capsule. Because the procedure ele vates muscles from the anterior and posterior aspects of the lateral s upracondylar osseous ridge, we called it the column procedure. The mea n preoperative are of flexion was 49 degrees (from 52 to 101 degrees). At a mean of forty-three months (range, twenty-four to seventy-four m onths) postoperatively, the mean are of flexion was 94 degrees (from 2 7 to 121 degrees). The mean total gain in the are of flexion-extension was 45 degrees; thirty-four elbows (89 percent) had an improved range of motion at the latest follow-up examination. Overall, thirty-one el bows (82 percent) had a satisfactory result. Greater improvement was o btained in elbows that had had severe stiffness (a total are of 31 to 60 degrees) or very severe stiffness (a total are of 30 degrees or les s) or that had had a combined flexion and extension contracture. A com plication occurred in four elbows (11 percent). A hematoma developed i n two elbows and impaired the final outcome in one of them. Two elbows had transient ulnar paresthesia, which resolved spontaneously. The ar e of flexion obtained at the time of the operation was lost in ten elb ows (26 percent) after an initial period of improvement; at the latest follow-up evaluation, four of these elbows had a mean decrease in the are of flexion of 24 degrees compared,vith preoperatively. The column procedure is associated with a low rate of complications and is safe and effective for the treatment of a limitation in flexion or extensio n resulting from an extrinsic contracture of the elbow.