Elbow arthrolysis for post-traumatic stiffness

Introduction The goal of the study was to determine the results of elbow arthrolyses for post-traumatic stiffness, and to identify factors governing the result of that procedure. Patients and Methods Between 1984 and 1997, 26 elbow arthrolyses were performed. Twenty three pa tients were retrospectively assessed by an independent examiner, 3 patients were lost for follow-up. The mean age at surgery was 41 years. The traumat isms responsible for stifness were: 5 elbow dislocations, 7 radial head fra ctures, 3 olecranon fractures, 8 humeral palette fractures. The surgical ap proach was 2 times posterior, 9 times lateral, 12 times combined (posterior and lateral). The surgical approach was chosen according to the preoperati ve analysis of the stiffness factors and the scars in case of previous surg ery. Results At follow-up (85 months (12-144)), 5 patients were very satisfied, 17 patie nts were satisfied and one patient was not satisfied. Six patients had disc omfort in daily gesture. Ten patients had no pain, 6 had pain while effort and 7 had climatic pain. Two ulnar palsies existing at arthrolysis did not improve after neurolysis and anterior ulnar nerve transposition. Range of m otion increased in every sector of mobility, and at follow-up mean ROM was: 121 degrees flexion, -31 degrees extension, 69 degrees pronation and 65 de grees supination. The average absolute benefit in flexion-extension was abo ut 38 degrees. The average relative (flexion-extension) benefit according t o Merle d'Aubigne was about 44 %. At follow-up, the average pronation-supin ation was higher than 100 degrees. The range of motion was not correlated t o the type of injury, to the surgical management, nor to the type of rehabi litation program. Likewise, the delay between traumatism and arthrolysis ha d no influence on the result. On the other hand, the range of motion was di rectly correlated to the preoperative mobility and mobility obtained just a fter surgery (p = 0.001). However, the range of motion at follow-up was sli ghtly decreased (5 degrees to 15 degrees) compared to the mobility obtained just after surgery. Discussion The final range of motion was mainly related to the severity of the preoperative stiffness. We noticed that few patients were bothered in d aily gestures, in spite of a relative stiffness. The type of injury did not seem to influence the final result. Elbow arthrolysis remains a mobilizati ng technique giving reliable long-lasting results. Conclusion The range of motion obtained after arthrolysis performed because of elbow post-traumatic contracture is mainly related to preoperative stiffness. By comparing with postoperative range of motion, a loss of 5 degrees to 10 degrees can be pr edicted.