Min Jong Park1, Moon Jong Chang1, Yong Beom Lee2, Hong Je Kang3. 1. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. E-mail address for M.J. Park: mjp3506@skku.edu. 2. Department of Orthopedic Surgery, Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang, Republic of Korea. 3. Department of Orthopaedic Surgery, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Jeollabuk-do, Republic of Korea.
Abstract
INTRODUCTION: We describe a surgical release for patients who have a lack of elbow flexion limiting the ability to perform activities of daily living after trauma. STEP 1 MOBILIZE THE ULNAR NERVE: Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels. STEP 2 DISSECT THE TRICEPS AND RESECT THE POSTERIOR ASPECT OF THE CAPSULE: Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa. STEP 3 RESECT THE POSTERIOR BAND OF THE MEDIAL COLLATERAL LIGAMENT: Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved. STEP 4 RESECT THE ANTERIOR ASPECT OF THE CAPSULE: Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion. STEP 5 LENGTHEN THE TRICEPS IF INDICATED: Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers. STEP 6 TRANSPOSE THE ULNAR NERVE ANTERIORLY: Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles. STEP 7 POSTOPERATIVE MANAGEMENT: Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months. RESULTS: Forty-two patients with <100° of elbow flexion as an extrinsic contracture following trauma had a surgical release of the elbow at a median of ten months postinjury. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: We describe a surgical release for patients who have a lack of elbow flexion limiting the ability to perform activities of daily living after trauma. STEP 1 MOBILIZE THE ULNAR NERVE: Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels. STEP 2 DISSECT THE TRICEPS AND RESECT THE POSTERIOR ASPECT OF THE CAPSULE: Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa. STEP 3 RESECT THE POSTERIOR BAND OF THE MEDIAL COLLATERAL LIGAMENT: Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved. STEP 4 RESECT THE ANTERIOR ASPECT OF THE CAPSULE: Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion. STEP 5 LENGTHEN THE TRICEPS IF INDICATED: Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers. STEP 6 TRANSPOSE THE ULNAR NERVE ANTERIORLY: Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles. STEP 7 POSTOPERATIVE MANAGEMENT: Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months. RESULTS: Forty-two patients with <100° of elbow flexion as an extrinsic contracture following trauma had a surgical release of the elbow at a median of ten months postinjury. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.