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Julian KR, Truong NM, Leversedge C, Kwong JW, Rosinski A, Kamal RN, Shapiro LM. Does Time to Surgery for Distal Radius Fractures Impact Clinical and Radiographic Outcomes? A Systematic Literature Review. CURRENT ORTHOPAEDIC PRACTICE 2023; 34:229-235. [PMID: 38264709 PMCID: PMC10802167 DOI: 10.1097/bco.0000000000001224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Distal radius fractures are one of the most common upper extremity fractures across all age groups. Although the American Academy of Orthopaedic Surgery (AAOS) Clinical Practice Guidelines have defined recommendations for the treatment of distal radius fractures, the optimal time to surgery was not included. There remains relatively little guidance or consensus regarding the optimal timing of surgical intervention for distal radius fractures and the impact of time to surgery on outcomes. As such, the purpose of this investigation is to systematically review clinical and radiographic outcomes associated with time to surgical management of distal radius fractures.
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Affiliation(s)
- Kaitlyn R Julian
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Nicole M Truong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Chelsea Leversedge
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street Redwood City, CA
| | - Jeffrey W Kwong
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
| | - Alexander Rosinski
- St. Mary's Medical Center, San Francisco Orthopaedic Residency Program 450 Stanyan Street San Francisco, CA 94117
| | - Robin N Kamal
- VOICES Health Policy Research Center Department of Orthopaedic Surgery, Stanford University 450 Broadway Street MC: 6342 Redwood City, CA
| | - Lauren M Shapiro
- Department of Orthopaedic Surgery, University of California - San Francisco 1500 Owens St. San Francisco, CA 94158
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Hall AT, Paul RW, Lencer A, Smith B, Ciccotti MG, Tjoumakaris FP, Erickson BJ. Incidence of Repeat Elbow Capsular Release After Arthroscopic Elbow Capsular Release. Orthop J Sports Med 2023; 11:23259671231190381. [PMID: 37655243 PMCID: PMC10467412 DOI: 10.1177/23259671231190381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/27/2023] [Indexed: 09/02/2023] Open
Abstract
Background Elbow capsular release can be performed arthroscopically or through an open method to improve range of motion (ROM). However, it is unclear how frequently patients require an open capsular release after unsatisfactory results from an arthroscopic release. Purpose/Hypothesis The purpose of this study was to determine the percentage of patients who underwent an arthroscopic elbow release for loss of motion who then required a repeat elbow capsular release or other subsequent surgery on the same elbow. It was hypothesized that patients who underwent arthroscopic elbow release would rarely (<5%) require a subsequent elbow release. Study Design Case series; Level of evidence, 4. Methods Patients who underwent arthroscopic elbow capsular release from January 1, 2010, to December 31, 2019, were identified by chart review and procedure code. Demographic parameters, pre- and postoperative ROM, and surgical history were collected by chart review. Follow-up data included patient satisfaction and the Timmerman-Andrews (TA) elbow score. Data were compared between patients who did and those who did not require subsequent elbow surgery. Results Overall, of 140 study patients (116 male, 24 female; mean age, 49.6 years), 18 (12.9%) required subsequent surgery, including 6 capsular releases (4.3%; 1 open and 5 arthroscopic). The most common follow-up procedure was ulnar nerve releases/transpositions (n = 7). Total arc of elbow motion (flexion to extension) improved by a mean of 51.4°. The mean TA score was 76.5 ± 20.4 at a mean of 5.25 years postoperatively. Mean satisfaction score was 77.6 ± 26.3. In this study, 82.4% of patients stated that their symptoms either improved or resolved completely. Patients who required subsequent surgery had a significantly lower preoperative total arc of elbow motion versus those who did not require subsequent surgery (P = .046). There was no difference between the groups in symptom resolution, satisfaction, ROM, or TA score (P ≥ .279 for all). Conclusion After arthroscopic elbow release, <5% of patients required a repeat elbow capsular release, 12.9% required some form of follow-up elbow surgery, and 4.3% had a new injury of the elbow. Overall, patients saw improvement in elbow ROM, but many still had residual symptoms from their underlying disease after arthroscopic elbow capsular release.
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Affiliation(s)
- Anya T. Hall
- Rothman Orthopaedic Institute, New York, New York, USA
| | - Ryan W. Paul
- Rothman Orthopaedic Institute, New York, New York, USA
| | - Adam Lencer
- Rothman Orthopaedic Institute, New York, New York, USA
| | - Brandon Smith
- Rothman Orthopaedic Institute, New York, New York, USA
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Sos C, Petit A, Brunet J, Rabarin F, Saint Cast Y, Raimbeau G, Bigorre N. Comparison of results of arthroscopic arthrolysis between traumatic and degenerative elbow stiffness. Orthop Traumatol Surg Res 2023; 109:103436. [PMID: 36241139 DOI: 10.1016/j.otsr.2022.103436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/31/2021] [Accepted: 11/15/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Elbow stiffness significantly affects the patient's quality of life. This joint must have at least 30°/130° extension/flexion and 50°/50° pronation/supination to function normally according to Morrey. HYPOTHESIS The objective of this study was to evaluate functional outcome of arthroscopic arthrolysis by comparing stiffness of post-traumatic and degenerative origin. The hypothesis was that this surgical technique allows functional improvement in any indication but with a faster result in degenerative pathology. MATERIAL AND METHODS This was a retrospective study including all patients who underwent elbow arthrolysis under arthroscopy, operated on by a single operator, between 2013 and 2020. Thirty-four patients were included, with a mean age of 45years (range, 18-78years). Patients were divided into two groups according to etiology. Group A (post-traumatic) consisted of 18 patients with a mean age of 33years (range, 18-64years) and group B (degenerative) of 16 patients with a mean age of 59years (range, 42-78years). All patients were clinically assessed at a mean 27months. Range of motion, level of satisfaction and Mayo Elbow Performance Score (MEPS) were collected. RESULTS In the overall series, preoperative range of motion was 81° and significantly improved postoperatively to 122° (p<0.001). The preoperative data of the 2 groups were comparable except for age (p<0.001) and MEPS (p=0.044). Postoperatively, range of motion improved significantly in both groups but with greater gain in group A (p=0.003). MEPS improved significantly in both groups, but the postoperative score was poorer in group B (p=0.001). Recovery of range of motion was faster in group B (2.4months) than in group A (3.7months) (p=0.021). There were 5 complications: 4 secondary decompensations of ulnar tunnel syndrome, and 1 postoperative radial nerve paresis. 94% of patients were satisfied or very satisfied with the result of surgery. CONCLUSION Arthroscopic arthrolysis is an effective option for post-traumatic and non-traumatic elbow stiffness. Improvement was significant in terms of both function and range of motion, with, however, better results in the post-traumatic group but results achieved more rapidly in the degenerative pathology group. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- Clara Sos
- Service de chirurgie orthopédique et traumatologique, unité de chirurgie de la main et des nerfs périphériques, Centre Hospitalier Régional Universitaire de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Alexandre Petit
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Jérôme Brunet
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Fabrice Rabarin
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Yann Saint Cast
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Guy Raimbeau
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
| | - Nicolas Bigorre
- Centre de la Main, 47, rue de la Foucaudière, 49800 Trélazé, France
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Abdul Azeem M, Alhojailan K, Awad M, Khaja AF. Post-traumatic radioulnar synostosis: a retrospective case series of 10 patients in Kuwait. J Shoulder Elbow Surg 2022; 31:1595-1602. [PMID: 35278681 DOI: 10.1016/j.jse.2022.01.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/22/2022] [Accepted: 01/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The development of radioulnar synostosis due to post-traumatic injuries of the elbow or forearm can lead to debilitating outcomes. Several treatment options are available to hinder the progression and prevent recurrence. We used a combination of these treatments in a series of patients and observed the outcomes. METHODS We conducted a retrospective study of 10 patients with post-traumatic radioulnar synostosis (9 men and 1 woman) who required surgical intervention in a tertiary orthopedic center. All of these patients were subjected to the same treatment combination (preoperative radiotherapy, tissue interposition after heterotopic ossification resection, and adjuvant indomethacin postoperatively). Improvement in range of motion (flexion, extension, and rotation) and the Mayo score was assessed and compared preoperatively and postoperatively via statistical analysis. RESULTS In comparison to the patients' preoperative state, which ranged from poor to fair, all 10 patients reported excellent Mayo scores after intervention with the triple therapy combination, with a mean Mayo score of 36 ± 10.2 points. Flexion, extension, and rotation improved by mean values of 55.2° ± 38.7°, 50.2° ± 34.0°, and 47.9° ± 40.0°, respectively. There was 1 complication that has subsided on follow-up. CONCLUSION The triple therapy combination was found to provide good functional and prophylactic results preventing recurrence.
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Affiliation(s)
- Mokhtar Abdul Azeem
- Faculty of Medicine, Al-Azhar University Hospital, Cairo, Egypt; Faculty of Medicine, Kuwait University Hospital, Kuwait City, Kuwait; Orthopedic Trauma Department, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
| | - Khalifa Alhojailan
- Department of Orthopaedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
| | - Mohammad Awad
- Department of Orthopaedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
| | - Aliaa F Khaja
- Orthopedic Trauma Department, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait.
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Liu W, Sun Z, Xiong H, Liu J, Lu J, Cai B, Wang W, Fan C. Development and validation of a prognostic nomogram for open elbow arthrolysis : the Shanghai Prediction model for Elbow Stiffness Surgical Outcome. Bone Joint J 2022; 104-B:486-494. [PMID: 35360939 PMCID: PMC9020519 DOI: 10.1302/0301-620x.104b4.bjj-2021-1326.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS The aim of this study was to develop and internally validate a prognostic nomogram to predict the probability of gaining a functional range of motion (ROM ≥ 120°) after open arthrolysis of the elbow in patients with post-traumatic stiffness of the elbow. METHODS We developed the Shanghai Prediction Model for Elbow Stiffness Surgical Outcome (SPESSO) based on a dataset of 551 patients who underwent open arthrolysis of the elbow in four institutions. Demographic and clinical characteristics were collected from medical records. The least absolute shrinkage and selection operator regression model was used to optimize the selection of relevant features. Multivariable logistic regression analysis was used to build the SPESSO. Its prediction performance was evaluated using the concordance index (C-index) and a calibration graph. Internal validation was conducted using bootstrapping validation. RESULTS BMI, the duration of stiffness, the preoperative ROM, the preoperative intensity of pain, and grade of post-traumatic osteoarthritis of the elbow were identified as predictors of outcome and incorporated to construct the nomogram. SPESSO displayed good discrimination with a C-index of 0.73 (95% confidence interval 0.64 to 0.81). A high C-index value of 0.70 could still be reached in the interval validation. The calibration graph showed good agreement between the nomogram prediction and the outcome. CONCLUSION The newly developed SPESSO is a valid and convenient model which can be used to predict the outcome of open arthrolysis of the elbow. It could assist clinicians in counselling patients regarding the choice and expectations of treatment. Cite this article: Bone Joint J 2022;104-B(4):486-494.
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Affiliation(s)
- Weixuan Liu
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Ziyang Sun
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Hao Xiong
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Junjian Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiuzhou Lu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Wang
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, China
| | - Cunyi Fan
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Engineering Research Center for Orthopedic Material Innovation and Tissue Regeneration, Shanghai, China
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Heterotopic Ossification Complicating Traumatic Ulnar Nerve Palsy in a Child. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4089. [PMID: 35169522 PMCID: PMC8830818 DOI: 10.1097/gox.0000000000004089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 11/26/2022]
Abstract
Heterotopic ossification (HO) refers to the process of forming bony tissues in extra-skeletal sites such as muscles and soft tissues. This pathological process most commonly commences following trauma, surgery, and fractures. Rarely, HO can compress nearby neurovascular structures. To the best of our knowledge, however, no previous reports exist of HO serving as second-hit to partially injured ulnar nerve in the pediatric population. We present a case of a 6-year-old girl with complete high ulnar nerve palsy caused by medial epicondylar fracture followed by development of HO around the elbow. The patient was initially managed conservatively. Four months after the first visit, she presented with complete ulnar nerve palsy that was not evident on the initial presentation. Based on further investigations, she was taken to OR for release of the cubital tunnel and anterior transposition of ulnar nerve. On further follow-up, the patient regained sensory and motor functions of the ulnar nerve with minimum sequalae. Post-traumatic ulnar nerve injury is well described in the literature as resulting from initial trauma or as an iatrogenic injury following fracture reduction and fixation. HO in the pediatric age group is considerably rare, occurring after trauma and burn injuries. Surgical timing of HO release remains controversial. No previous reports of HO complicating traumatic ulnar nerve palsy in pediatric patients exist. In the current case report, partial ulnar nerve injury was initially due to medial epicondylar fracture, but it had progressed to full blown ulnar palsy secondary to superimposed HO. Early HO takedown combined with decompression of ulnar nerve are crucial to ensure complete nerve recovery.
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Ruan JH, Cui HM, Sun ZY, Chen S, Wang W, Fan CY. Midterm Outcomes After Open Arthrolysis for Posttraumatic Elbow Stiffness in Children and Adolescents. J Pediatr Orthop 2021; 41:e266-e271. [PMID: 33492039 PMCID: PMC7952043 DOI: 10.1097/bpo.0000000000001748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Open arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open arthrolysis in children and adolescents with posttraumatic elbow stiffness. METHODS Data of 31 children and adolescents with posttraumatic elbow stiffness following open arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables. RESULTS The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy. CONCLUSIONS Most patients showed satisfactory functional outcomes after arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Ji-hao Ruan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Hao-min Cui
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Zi-yang Sun
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Shuai Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
| | - Wei Wang
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
| | - Cun-yi Fan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital
- Department of Orthopedics, Shanghai University of Medicine and Health, Shanghai Sixth People’s Hospital East Campus, Shanghai, China
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Guglielmetti CLB, Gracitelli MEC, Assunção JH, Andrade-Silva FB, Pessa MMN, Luzo MC, Ferreira Neto AA, Malavolta EA. Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation. J Shoulder Elbow Surg 2020; 29:1522-1529. [PMID: 32713463 DOI: 10.1016/j.jse.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/14/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are no previous randomized trials comparing surgical to conservative treatment for post-traumatic elbow stiffness. The aim of our study was to compare elbow range of motion (ROM) and clinical outcomes among patients undergoing surgical treatment or a standardized rehabilitation for post-traumatic elbow stiffness. METHODS Randomized clinical trial of patients with post-traumatic elbow stiffness for more than 6 months who failed conventional physical therapy for 4 months. Patients were randomized into 2 treatment groups. The conservative group underwent the rehabilitation protocol associated with the use of orthoses (static progressive for extension and dynamic for flexion) and continuous passive motion. The surgical group underwent surgical release by a posterior approach without triceps detachment, followed by a rehabilitation protocol similar to the conservative group. The primary outcome of the study was flexion-extension ROM at 6 months of follow-up. Secondary outcomes included the visual analog scale for pain, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder, and Hand score, absolute and relative increase in flexion-extension ROM, and complication rates. RESULTS Thirty patients were analyzed in the study, 15 in each group. The mean elbow flexion-extension ROM at the end of 6 months of follow-up was 108° in the surgical group and 88° in the conservative group (P = .002). The mean absolute and the relative increase of elbow flexion-extension at 6 months were, respectively, 17° and 27% in the conservative group and 41° and 59% in the surgical group (P < .001). CONCLUSION Surgical elbow release associated with the rehabilitation protocol resulted in a greater flexion-extension ROM, as well as a greater absolute and relative increase compared with rehabilitation alone at 6 months of follow-up. The groups did not differ regarding clinical scores and complication rates.
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Affiliation(s)
- César L B Guglielmetti
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mauro E C Gracitelli
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Jorge H Assunção
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Fernando B Andrade-Silva
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana M Nicolosi Pessa
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Candida Luzo
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Arnaldo A Ferreira Neto
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo A Malavolta
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Geyer S, Imhoff AB, Siebenlist S. Komplikationsmanagement – Ellenbogenarthrolyse. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zhang D, Nazarian A, Rodriguez EK. Post-traumatic elbow stiffness: Pathogenesis and current treatments. Shoulder Elbow 2020; 12:38-45. [PMID: 32010232 PMCID: PMC6974890 DOI: 10.1177/1758573218793903] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/08/2018] [Indexed: 12/16/2022]
Abstract
Post-traumatic elbow stiffness is a major cause of functional impairment after elbow trauma. A stiff elbow limits patients' ability to position their hand in space for optimal use of their upper extremities, and as such, is a frequent indication for reoperation. This article reviews current concepts on the pathogenesis of post-traumatic elbow stiffness. Current nonoperative treatment options include therapy, bracing, and manipulation under anesthesia, while operative treatment options include arthroscopic and open arthrolysis. The pros and cons of various treatment options are discussed, with a focus on the evidence supporting their use, the expected functional gains, and associated complications. Future directions in post-traumatic elbow stiffness are highlighted.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Beth
Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
- Harvard Medical School, Boston, MA,
USA
| | - Ara Nazarian
- Harvard Medical School, Boston, MA,
USA
- Center for Advanced Orthopaedic Studies,
Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
- Department of Orthopaedic Surgery,
Yerevan State Medical University, Yerevan, Armenia
| | - Edward K Rodriguez
- Department of Orthopaedic Surgery, Beth
Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
- Harvard Medical School, Boston, MA,
USA
- Center for Advanced Orthopaedic Studies,
Beth Israel Deaconess Medical Center (BIDMC), Boston, MA, USA
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Zheng X, Yang M, Mu M, Kang X, Yang A, Zhou B, Tang K. [Mid-term effectiveness of arthrolysis and hinged external fixation for treatment of stiff elbow caused by heterotrophic ossification]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1299-1304. [PMID: 31544443 DOI: 10.7507/1002-1892.201902002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the mid-term effectiveness of arthrolysis and hinged external fixation for the treatment of stiff elbow caused by heterotrophic ossification. Methods Between January 2014 and December 2017, 11 patients with stiff elbow caused by heterotrophic ossification were admitted. There were 9 males and 2 females with an average age of 32 years (range, 14-48 years), and left side in 6 cases and right side in 5 cases. The cause of stiff elbow included humerus fracture in 5 cases, ulna fracture in 2 cases, fracture of capitulum radii in 1 case, dislocation of capitulum radii in 1 case, terrible triad of the elbow in 1 case, and soft tissue injury in 1 case. The disease duration ranged from 7 to 18 months (mean, 11 months). Preoperative active range of motion of elbow was (19.6±17.5)° and Mayo score was 34.1±9.7. All patients received the treatment of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator, and active and passive rehabilitation with the help of hinged external fixator. The hinged external fixators were removed after 2 months. Results All patients were followed up 13-36 months (mean, 19.1 months). All incisions healed by first intention, and no complication of infection or nerve lesion occurred postoperatively. At last follow-up, the results of X-ray films showed that no heterotrophic ossification recurred. The active range of motion of elbow was (116.4±16.6)° and Mayo score was 93.2±7.8, showing significant differences when compared with preoperative ones ( t=17.508, P=0.000; t=16.618, P=0.000). Conclusion The application of arthrolysis and debridement of heterotrophic ossification lesion combining hinged external fixator can improve the elbow's range of motion significantly and obtain a good mid-term effectiveness.
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Affiliation(s)
- Xiaolong Zheng
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000, P.R.China
| | | | - Miduo Mu
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000, P.R.China
| | - Xia Kang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000, P.R.China
| | - Aining Yang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000, P.R.China
| | - Binghua Zhou
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000,
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of Army Medical University of Chinese PLA, Chongqing, 445000,
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Sun Z, Cui H, Liang J, Li J, Wang X, Fan C. Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study. BMC Musculoskelet Disord 2019; 20:122. [PMID: 30909899 PMCID: PMC6434886 DOI: 10.1186/s12891-019-2506-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 03/13/2019] [Indexed: 01/17/2023] Open
Abstract
Background Following trauma, the elbow is the most susceptible to restricted motion among all joints. Open arthrolysis is often performed for post-traumatic elbow stiffness if that stiffness does not improve with non-operative management. However, the optimal timing for performing an open arthrolysis remains controversial. The purpose of this study was to compare the outcome (elbow motion and function) and the rate of complications among patients who had undergone early, median and late release procedures to establish an optimal time interval following the injury, after which, an effective open arthrolysis can be performed. Methods In this retrospective cohort study, we included total 133 patients, who had undergone open arthrolysis for post-traumatic elbow stiffness. The subjects were divided into 3 groups, with 31 patients in the early release group (arthrolysis performed at 6–10 months after injury), 78 patients in the median release group (at 11–20 months), and 24 patients in the late release group (at > 20 months). The release procedure in all patients was performed by the same surgeon, using the same technique. The general data, functional performance, and complications, if any, were retrospectively documented for all patients and statistically analysed. Results The demographic data and disease characteristics of all patients were comparable at baseline. Postoperatively, no significant differences were found among the three groups with respect to the range of motion (p = 0.067), Mayo Elbow Performance Score (p = 0.350) and its ratings (p = 0.329), visual analog scale score for pain (p = 0.227), Dellon classification for ulnar nerve symptoms (p = 0.497), and each discrete complication (all p values > 0.05). Conclusions At the final follow-up, our results showed no significant difference in the postoperative elbow motion capacities, functional scores and the rates of complications among patients who had undergone an early, median, and late release. Therefore, we have recommended that an early arthrolysis would be preferable due to its multiple advantages, and the conventionally observed interval of > 1 year after the injury, could be shortened. Level of evidence Level III; Retrospective Cohort Design; Therapeutic Study.
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Affiliation(s)
- Ziyang Sun
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Haomin Cui
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Jiaming Liang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Juehong Li
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Xu Wang
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Cunyi Fan
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China. .,Department of Orthopedics, Shanghai Sixth People's Hospital East Affiliated to Shanghai University of Medicine & Health Sciences, Shanghai, People's Republic of China.
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