OPERATIVE MANAGEMENT OF THE STIFF ELBOW - SEQUENTIAL ARTHROLYSIS BASED ON A TRANSHUMERAL APPROACH

Between December 1990 and September 1993, 26 consecutive patients (27 elbows) were treated for elbow confractures. We used a modified transh umeral approach supplemented by a limited lateral approach with or wit hout a limited medial approach according to the correction gained afte r each step of the procedure. Eleven posttraumatic, 6 degenerative, an d 10 miscellaneous contractures were evaluated. The mean follow-vp was 30 months. Statistically significant improvement in the range of moti on was obtained for all groups of patients; the mean flexion-extension arc of motion increased from 66 degrees to 100 degrees for the posttr aumatic contractures, from 79 degrees to 102 degrees for the degenerat ive contractures, and from 85 degrees to 121 degrees for a miscellaneo us group of confractures. Relief of pain was not an issue in the postt raumatic group; if was not significant for the degenerative group but was significant for the miscellaneous group. Flexion and extension for ce were maintained, and no joint was made unstable. Complications incl uded three transient ulnar neuropathies and one tardy ulnar nerve pals y. The technique presented offers the advantage of virtually unlimited exposure of the joint in a stepwise manner, dictated by the intraoper ative assessment of joint motion combined with preservation of the med ial and lateral collateral ligament complexes and all relevant muscle insertions and origins. The concept is applicable to contractures of d iffering cause and can be adapted to the specific needs of the patient .