David Ring1, Jesse B Jupiter1. 1. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail address for D. Ring: dring@partners.org.
Abstract
INTRODUCTION: Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness. STEP 1 SKIN INCISION: Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions. STEP 2 PROTECT OR RELEASE PERIPHERAL NERVES: Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used. STEP 3 DEVELOP MUSCLE INTERVALS FOR EXPOSURE OF THE JOINT: Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule. STEP 4 RESECT BONE CONTRACTED CAPSULE AND IMPLANTS RESTRICTING MOTION: Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule. STEP 5 TENOLYSIS/MUSCLE ELEVATION: When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator. STEP 6 MANIPULATE ELBOW CONSIDER IMPLANT REMOVAL: Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants. STEP 7 WOUND CLOSURE: Close the muscle intervals and skin. STEP 8 POSTOPERATIVE MANAGEMENT: The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches. RESULTS: A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
INTRODUCTION: Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness. STEP 1 SKIN INCISION: Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions. STEP 2 PROTECT OR RELEASE PERIPHERAL NERVES: Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used. STEP 3 DEVELOP MUSCLE INTERVALS FOR EXPOSURE OF THE JOINT: Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule. STEP 4 RESECT BONE CONTRACTED CAPSULE AND IMPLANTS RESTRICTING MOTION: Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule. STEP 5 TENOLYSIS/MUSCLE ELEVATION: When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator. STEP 6 MANIPULATE ELBOW CONSIDER IMPLANT REMOVAL: Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants. STEP 7 WOUND CLOSURE: Close the muscle intervals and skin. STEP 8 POSTOPERATIVE MANAGEMENT: The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches. RESULTS: A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°. WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
Authors: Anneluuk L C Lindenhovius; Durk S Linzel; Job N Doornberg; David C Ring; Jesse B Jupiter Journal: J Shoulder Elbow Surg Date: 2007-07-23 Impact factor: 3.019