Risk Factors for the Occurrence and Progression of Posttraumatic Elbow Stiffness: A Case-Control Study of 688 Cases

Management of the stiff elbow: a literature review

The elbow is prone to stiffness due to its unique anatomy and profound capsular reaction to inflammation. The resulting movement impairment may significantly interfere with a patient's activities of daily living. Trauma (including surgery for trauma), posttraumatic arthritis, and heterotopic ossification (HO) are the most common causes of elbow stiffness. In stiffness caused by soft tissue contractures, initial conservative treatment with physiotherapy (PT) and splinting is advised. In cases in which osseous deformities limit range of motion (e.g. malunion, osseous impingement, or HO), early surgical intervention is recommended. Open and arthroscopic arthrolysis are the primary surgical options. Arthroscopic arthrolysis has a lower complication and revision rate but has narrower indications. Early active mobilization using PT after surgery is recommended in postoperative rehabilitation and may be complemented by splinting or continuous passive motion therapy. Most results are gained within the first few months but can continue to improve until 12 months. This paper reviews the current literature and provides state-of-the-art guidance on the management regarding prevention, evaluation, and treatment of elbow stiffness.

A novel mouse model of hindlimb joint contracture with 3D-printed casts

Stiff joints formed after trauma, surgery or immobilization are frustrating for surgeons, therapists and patients alike. Unfortunately, the study of contracture is limited by available animal model systems, which focus on the utilization of larger mammals and joint trauma. Here we describe a novel mouse-based model system for the generation of joint contracture using 3D-printed clamshell casts. With this model system we are able to generate both reversible and irreversible contractures of the knee and ankle. Four- or 8-month-old female mice were casted for either 2 or 3 weeks before liberation. All groups formed measurable contractures of the knee and ankle. Younger mice immobilized for less time formed reversible contractures of the knee and ankle. We were able to generate irreversible contracture with either longer immobilization time or the utilization of older mice. The contracture formation translated into differences in gait, which were detectable using the DigiGait® analysis system. This novel model system provides a higher throughput, lower cost and more powerful tool in studying the molecular and cellular mechanisms considering the large existing pool of transgenic/knockout murine strains.

Comparative Study Between the Mini-Open (≤2.5 Cm) Approach and Conventional Open Lateral Approach in the Surgical Treatment of Radial Head Fractures

Purpose

The conventional lateral approach is widely used to treat radial head fractures with screws. However, the traditional incision may have shortcomings, including excessive exposure and significant scarring. We propose an innovative method – a mini-open lateral approach of less than 2.5 cm for surgical treatment of radial head fractures with screws.

Methods

From Jan 2017 to Dec 2020, 34 patients diagnosed with closed radial head fracture were treated with open reduction and internal fixation (ORIF) in this study. The novel group (mini-open group) included 15 patients, and the other 19 patients were in the traditional group. The time of operation and the blood loss during operation were recorded. Postoperative clinical outcomes and radiographic results were recorded and compared between the two groups. The range of motion (ROM) in the elbow, the Visual Analogue Scale (VAS), the Mayo Elbow Performance Score (MEPS), Rating Scale of the American Shoulder and Elbow Surgeons (ASES), and the Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire (Q-DASH) score and complications, such as wound infection, vascular and nerve damage, and fragment redisplacement were observed in the two groups.

Results

In the comparison between the two groups, there was no significant difference in age, sex, cause of radial head fracture, or other basic information. The operation time, intraoperative blood loss, and VAS score at 3 days postoperation were significantly reduced in the novel group (p < 0.05). The follow-up results showed that there was no significant difference in MEPS, ASES, or Q-DASH scores between the two groups.

Conclusion

The mini-open approach reduced intraoperative blood loss, shortened operation time, relieved patient pain, and achieved a satisfactory postoperative clinical result, which demonstrates that the novel approach is a safe and effective option for treating radial head fractures.

Features of the Rehabilitation of Patients with Fractures of the Humeral Diaphysis after Osteosynthesis

Aim: Determination of the target criteria of physical rehabilitation and the optimal time of their implementation depending on the methods of fixation of fractures of the humeral diaphysis. Materials and methods: The results of treatment of 59 patients with diaphyseal humeral fractures have been studied. All patients underwent extra- or intramedullary osteosynthesis. Results: In the absence of satisfactory stability of fracture fixation (Group A), passive movements and no active movements are recommended, especially in the presence of free bone fragments that serve as a site for muscle insertion (Group A1). The presence of free fragments with stable fixation (Groups B1 and B2) determined the possibility of active adduction and abduction movements of the shoulder. Complexes of physical rehabilitation exercises with the exclusion or prohibition of active rotational movements have been chosen for patients of Groups C1 and C2. Conclusions: The proposed system of distribution of physical load during the rehabilitation period according to the “ABC” type provides a biomechanically based approach to the rehabilitation process.

Biomechanical Evaluation of a Low-Invasive Elbow Medial Collateral Ligament Reconstruction Technique With Fascia and Tendon Patches

Background: Injury to the medial collateral ligament (MCL) of the elbow has become increasingly common in sports, and the elbow is prone to contracture and ossification in trauma. Effective reconstruction of the MCL with reduction of irritation to the elbow has rarely been reported. This study introduces a minimally invasive elbow MCL reconstruction technique and evaluates the valgus stability.

Methods: Eight fresh-frozen elbow specimens underwent reconstruction of the anterior bundle of the MCL (AMCL) first with the flexor carpi ulnaris fascia patches, followed by reconstruction of the posterior bundle of the MCL (PMCL) with the triceps tendon patches. The valgus angles of each specimen were examined in three stages as follows: intact MCL, reconstruction of the AMCL alone, and reconstruction of the MCL (including AMCL and PMCL). Finally, specimens were loaded to failure, and failure modes were recorded.

Results: AMCL reconstruction alone had similar valgus stability at all testing angles (p = 0.080, 30° flexion; p = 0.064, 60° flexion; p = 0.151, 90° flexion; p = 0.283, 120° flexion) compared with the intact MCL, as did MCL reconstruction (p = 0.951, 30° flexion; p = 0.739, 60° flexion; p = 0.841, 90° flexion; p = 0.538, 120° flexion). More importantly, a significant difference existed between the MCL reconstruction and the AMCL reconstruction alone at 30° flexion (p = 0.043) and 60° flexion (p = 0.013) but not at the 90° flexion (p = 0.369) and 120° flexion (p = 0.879). The mean maximum failure torque of MCL reconstruction was 24.02 Nm at 90° elbow flexion.

Conclusion: Both AMCL reconstruction alone and MCL reconstruction provided valgus stability comparable with the native MCL, and importantly, MCL reconstruction provided more valgus stability than AMCL reconstruction alone at 30° flexion and 60° flexion of the elbow. Therefore, the new MCL reconstruction technique might be a useful guide for the treatment of elbow MCL injuries or deficiencies.

Elbow Stiffness Imaging: A Practical Diagnostic and Pretherapeutic Approach

Loss of elbow motion can lead to disability in everyday gestures, recreational activities, and work. Unfortunately, the elbow joint is particularly prone to stiffness because of its complex anatomy and biomechanics. The etiology of elbow stiffness is varied and must be diagnosed accurately in order to allow optimal treatment, which may be challenging for surgeons and physiotherapists. Its treatment can be either conservative, arthroscopic or surgical, with a trend for arthroscopic procedures when conservative treatment fails. There is no consensus on the optimal imaging workup for elbow joint stiffness, which may have an impact on patient management. This article reviews the current classification systems of elbow stiffness and the various imaging techniques used for diagnosis. Report checklists and clarifications on the role of each imaging method, as well as the imaging findings of normal and stiff elbows, are presented, leading to a proposed diagnostic algorithm. The main concern in imaging is to determine the cause of elbow stiffness, as many concomitant abnormalities might be present depending on the clinical scenario.