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Elbow arthrolysis is the most commonly used treatment for elbow stiffness. Ulnar nerve complications are one of the most important evaluation indicators of postoperative health status. However, there is no consensus on the management of ulnar nerve and the control of surgical indications. Combining relevant literature and clinical experience, this review discussed the necessity of ulnar nerve release and the choice of ulnar nerve operations during elbow arthrolysis with or without preoperative ulnar nerve symptoms. It is considered that more attention should be paid to the management of ulnar nerve complications and further research should be performed.
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Objective:To study the clinical efficacy of modified open elbow arthrolysis in the treatment of traumatic elbow stiffness.Methods:A retrospective analysis was performed on 120 patients who underwent modified open elbow arthrolysis in Beijing Jishuitan Hospital from January 2018 to December 2020. The age of the included patients was (37.7±12.4) years (ranged 18-64 years), including 54 males and 66 females. The medical records were reviewed, the range of motion (ROM) and functional status of the patients before operation and at the last follow-up were compared including visual analogue scale (VAS), Mayo elbow performance score (MEPS), Disabilities of the arm, shoulder and hand (DASH) score. Complications and secondary operations were also recorded. Measurement data with normal distribution were presented as mean ± standard deviation( ± s) and comparison between groups was conducted using the t-test; Measurement data of skewed distribution were expressed as M ( Q1, Q3), and Rank-sum test was used for inter-group comparison. Results:The preoperative extension of 120 patients was 43.6° (33.8°, 60.1°), the flexion was 78.7° (59.8°, 98.1°), and the flexion-extension ROM was 25.6° (0.0°, 54.5°); the preoperative pronation was 51.8° (33.0°, 67.0°), the supination was 85.1° (65.7°, 90.0°), and the rotation ROM was 136.9° (99.1°, 157.5°). Postoperative extension was 14.2° (7.0°, 24.8°), flexion was 129.5° (120.0°, 138.1°), flexion-extension ROM was 115.5° (94.4°, 127.3°); postoperative pronation was 65.0° (47.1°, 75.0°), the supination was 88.3° (78.6°, 90.0°), and the rotation ROM was 151.9° (131.7°, 163.4°). Postoperative extension, flexion, flexion-extension ROM, pronation, supination, and rotation ROM were all higher than those before operation, and the differences were statistically significant ( P<0.001). The VAS of 120 patients was 1.0 (0.0, 3.0) scores before operation and 0.0 (0.0, 1.0) scores after operation. The MEPS was 60.0 (50.0, 75.0) scores before operation and 100.0 (85.0, 100.0) scores after operation. The preoperative DASH was 37.5 (20.1, 51.3) scores, and the postoperative DASH was 7.9 (3.3, 13.3) scores. The postoperative VAS, MEPS, and DASH were significantly improved compared with those before operation, and the differences were statistically significant ( P<0.001). Residual ulnar nerve symptoms occurred in 18 cases, recurrence of heterotopic ossification in 42 cases, and hematoma in 3 cases. Conclusions:Modified open elbow arthrolysis is a safe and effective surgical method for the treatment of traumatic elbow stiffness. It can significantly improve the function of the patient, reduce the occurrence of elbow instability, avoid the use of external fixators, and reduce the cost of the patient.
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Objective:To investigate the clinical efficacy and indications of arthrolysis plus Ilizarov technique in the treatment of traumatic fibrous stiffness of the knee.Methods:The clinical data were analyzed retrospectively of the 9 patients (10 knees) with traumatic fibrous stiffness who had been treated by arthrolysis plus Ilizarov technique from January 2012 to December 2020 at Department of Orthopaedics, Rehabilitation Hospital of National Research Center for Rehabilitation Technique Aids. There were 8 males and one female, aged from 15 to 42 years (average, 30.2 years). The left side was affected in 2 cases, the right side in 6 ones and bilateral sides in one. Their knee stiffness was all caused by injury around the knee. The time from injury to treatment ranged from 12 months to 38 years (average, 16.5 years). The admission examination revealed that the knee extension ranged from -40° to 0° and the knee flexion from -10° to 40°. Wearing time for the external fixator and incidence of complications were recorded; the ranges of knee motion were compared before and after treatment; the Qin Sihe criteria for postoperative limb deformity correction were used at the last follow-up to evaluate the curative efficacy.Results:The 9 patients were followed up for 20 to 78 months with an average of 35 months. The external fixators were worn for 14 to 200 days with an average of 78.4 days. During the traction period, pin tract reaction (3 holes) occurred in 2 patients with 3 knees, pin tract infection (2 holes) in 2 patients with 2 knees, the incision healed poorly in one patient, and no other complications occurred. The functional recovery of the knee was good at the last follow-up. The knee extension was 0°, insignificantly different from the preoperative value (-6.5°±12.9°) ( t=-1.591, P=0.146); the flexion angle was 70.0°±17.6°, significantly better than the preoperative value (15.0°±17.2°) ( t=-6.822, P< 0.001). According to the Qin Sihe postoperative criteria, the curative efficacy at the last follow-up was excellent in 7 knees and good in 3. Conclusion:In the treatment of traumatic fibrous stiffness of the knee, when the efficacy of simple arthrolysis is not good enough, a combination with Ilizarov technique can help improve the postoperative knee function and prevent severe complications.
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Objective:To investigate the efficacy of TiRobot navigation for hinged external fixation in elbow arthrolysis.Methods:The 11 patients were retrospectively analyzed who had been treated by elbow arthrolysis at Department of Traumatology and Orthopedics, Beijing Jishuitan Hospital using TiRobot navigation for hinged external fixation. There were 9 males and 2 females with a mean age of 39.3 years (from 21 to 66 years). Their elbow range of motion (ROM) was compared between preoperation and the final follow-up. Their visual analogue scale (VAS) and Mayo elbow performance score (MEPS) and complications were documented at the final follow-up.Results:The rotation axis of the elbow joint was positioned with the aid of intraoperative robot navigation in 11 patients.The deviation of entry point averaged 0.21 mm (from 0.05 to 0.41 mm) and the deviation of exit point 0.23 mm (from 0.06 to 0.38 mm). The follow-up time for the 11 patients averaged 25.8 months (from 16 to 32 months). Their elbow flexion and extension was 133.0° (134.9°, 138.7°) and rotation 164.6° ±17.5° at the final follow-up, significantly improved compared with their preoperative values [0.8°(0°, 33.7°) and 122.9°±49.0°] ( P<0.05). Their VAS averaged 0.2 (from 0 to 1) and MEPS 96.8 (from 85 to 100) at the final follow-up, giving 9 excellent and 2 good cases. There was no case of radial nerve injury, pin instability, pin breakage, pin infection or peri-pin fracture. Conclusion:When TiRobot navigation is used for hinged external fixation in elbow arthrolysis, the axis of rotation can be accurately located, leading to satisfactory functional outcomes for the patients.
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Objective: To objectively evaluate the short-term and long-term efficacies of arthrolysis under brachial plexus anesthesia in treating adhesive capsulitis of the shoulder (ACS). Methods: One hundred patients diagnosed with ACS were divided into two groups using the random number method. The two groups both received same active rehabilitation exercises. Besides, 55 cases in the treatment group were given one session of arthrolysis under brachial plexus anesthesia, and 45 cases in the control group were given tuina treatment. Changes in the visual analog scale (VAS) score, Melle score and pressure pain index were observed 1 month and 3 months after treatment. The therapeutic efficacies were also compared. Results: The total effective rate was 96.4％ at the 1-month follow-up and 96.4％ at the 3-month follow-up in the treatment group. The total effective rate was 33.3％ at the 1-month follow-up and 28.9％ at the 3-month follow-up in the control group. There were significant differences between the two groups comparing the total effective rate at the two time points (both P<0.05). The scores of VAS, Melle and pressure pain were significantly different at the 1-month and 3-month follow-ups from those before treatment in the treatment group (all P<0.05); the three scores did not show significant differences at the 1-month and 3-month follow-ups compared with those before treatment in the control group (all P>0.05). Conclusion: Based on the active rehabilitation exercises, one session of arthrolysis under brachial plexus anesthesia can release the adhesion and restore the range of motion and function of shoulder joint in ACS patients. It is superior to rehabilitation exercises plus tuina treatment comparing both short-term and long-term efficacies.
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@#Introduction: The stiffness of elbow joint severely interferes with functional ability of upper limb. Open arthrolysis, in young active patients were reported with inconsistent results may be due to its applications in injudiciously selected cases. The objective of this study was to analyse the pathological abnormalities of stiff elbows for their classification and appropriate planning of surgical management to get maximum benefit following the arthrolysis. Methods: 98 patients of ages varied from eight to 62 (mean 23.3) years with posttraumatic stiff elbows having nonfunctional arc less than 70o of flexion predominantly extra articular contracture with maintenance of radiological congruence of humeroulnar joint of five to 26 (mean 14.65) months duration were included . The ankylosed elbows based on their clinicoradiological assessment were divided into three groups and subjected to open arthrolysis. 84 patients were clinicoradiologically evaluated during 3.2 to 10.3 (mean 6.5) years follow up. Results: The patients of Group I & II having predominantly soft tissue contractures showed overall highly satisfactory and excellent results in majority. The patients of Group III having additional periarticular new bone formation with subchondral sclerosis obtained good results. The cause and duration of contractures did not seem to influence the outcome of arthrolysis. The judicious and sequential release of contracture structure is effective to regain satisfactory to elbow motion. Conclusion: Thus, judicious preoperative selection of stiff elbow is mandatory to obtain favorable functional outcome after arthrolysis.
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The elbow is more susceptible to motion loss than other joints after trauma,and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities.Open arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness.In this paper,we review the treatment protocols like preoperative clinical evaluation,arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness,discuss relevant issues and assess their prospects.
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Objective: To evaluate the effectiveness of open arthrolysis in treatment of the patient with stiff knee in late stage after primary total knee arthroplasty (TKA). Methods: Between January 2014 and October 2017, 7 female patients (7 knees) with stiff knee in late stage after primary TKA were admitted. The patients were 57-71 years old (mean, 63 years). There were 2 left knees and 5 right knees. All patients underwent TKA because of knee osteoarthritis. The interval between TKA and open arthrolysis was 8-30 months (mean, 13.6 months). There were 4 patients with 10-20° of extension deficit before arthrolysis. The range of motion of knee was (54.3±12.1)°. The clinical score, functional score, and total score of Knee Society Score (KSS) before arthrolysis were 76.3±7.6, 67.9±11.1, and 144.1±16.1, respectively. During the arthrolysis, periarticular soft tissue scar was removed, the range of motion of knee was restored, the gap balance and well patellar tracking were maintained. Intensive rehabilitation after operation was supplemented. Results: All wounds healed by first intention, without early stage complications. All patients were followed up 12-32 months with an average of 20.1 months. No abnormality of prosthesis was found by post-operative X-ray films. The knee movement improved significantly when compared with that before arthrolysis. The range of motion was less than 90° in 1 patient and 10° of extension deficit remained in 1 patient after operation. The range of motion was (92.9±4.9)° at last follow-up. The clinical score, functional score, and total score of KSS were 81.9±5.1, 74.3±9.8, and 156.1±13.7, respectively at last follow-up. The above indexes were superior to those before operation ( P<0.05). Conclusion: Open arthrolysis combined with intensive rehabilitation is a significant way to improve knee function for the patient with stiff knee in late stage after primary TKA.
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Objective To evaluate the clinical results of arthroscopic arthrolysis for the treatment of elbow stiffness.Methods Totally 34 cases with elbow stiffness caused by trauma who needed to undergo arthroscopic arthrolysis were selected from General Hospital of Shenyang Military Area Command from October 2014 to February 2016.Among them,3 cases were lost to follow-up,and the other 31 cases were included in the study.All the patients were performed arthroscopic arthrolysis.Removed the hyperplasia of osteophyte and girdle,cleaned the articular cavity,restored the smooth of articular surface,and released the joint capsular and ligament around the elbow joint during the operation.Manipulation release was used coordinate with analgesia and rehabilitation therapy after operation.Mayo scores of elbow were used for function evaluation and range of motion(ROM) was collected.Results Patients were followed-up from 9 months to 12 months,(10.4±1.5) months on average.Before the operation,the mean maximal flexion angle of the elbow was (87.6±5.9)°,the extension angle was (35.5±6.4)°,the pronation angle was (75.9±9.6)°,the rotational angle was (67.2±7.4)°,and it was (125.9±6.5)°,(5.0±1.9)°,(82.0±9.1)°,(81.0±7.0)°respectively after operation,and the differences before and after opreation were statistically significant (P<0.05).The Mayo scores was (61.9±7.6) preoperatively and (88.8±4.7) postoperatively,and the difference was statistically significant(P<0.05).Conclusion Arthroscopic arthrolysis has the advantages of clear operative field,minimal invasion and rapid recovery.It can effectively improve the elbow joint activity and arthroscopic arthrolysis is an effective surgical treatment for elbow stiffness.
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Objective To discuss clinical efficacy of patients treated with surgical treatment for posttraumatic elbow stiffness combined with pain.Methods From January 2011 to December 2014,release treatment was performed on 32 cases of posttraumatic contracture of the elbow combined with pain by operation.There were 22 males and 10 females,at average age of 39 years(range from 18 to 65 years).25 cases of these patients with mild-to-moderate pain got a simple elbow release operation.There were 4 cases of severe pain patients complicated with elbow dislocation,after fully release the elbows,reduction was performed under the direct;Both elbow arthrolysis and dermal transplantation interval type elbow arthroplasty were performed in 3 cases of severe pain patients which had severe osteoarthritis.A total of 26 patients were installed hinged external fixator after operation for early functional exercise.Results All patients were followed up for an average time of 14 months(from 12 to 18 months).All patients were significantly improved in the range of elbow and pain symptoms.Postoperative joint function improvement:2 patients with severe stiffness improved to moderate stiffness,19 patients with moderate or severe stiffness improved to mild stiffness,and the remaining of 11 cases without stiffness,The improvement rate was 100％.Postoperative pain:6 cases of moderate or severe pain relieved for mild pain,26 patients pain disappeared,the pain relief rate was 100％.Mayo elbow performance score were evaluated before and after surgery.Preoperative score:the results were good in 6 cases,fair in 14 cases and poorin 12 cases;postoperative score:excellent in 20 cases,good in 8 cases and fair in 4 cases,the good rate is 87.5 ％.The difference between preoperation and postoperation was statistically significant (P＜0.05).Conclusion Elbow arthrolysis combined external fixation is beneficial to early functional rehabilitation and restoring the flexion and extension function of stiff elbow,at the same time,the pain caused by stale dislocation or arthritis of elbow can also get good effect.
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Objective To observe the clinical efficacy of combining buprenorphine with joint mobilization in the treatmeut of periarthritis of the shoulder.Methods A total of 103 patients were randomly divided into groups A,B and C.Group A received buprenorphine and joint mobilization;group B was treated with the non-steroidal antiinflammatory drug loxoprofen sodium and joint mobilization;group C received only joint mobilization.One week,3 weeks and three months after the treatment,the subjects used a visual analogue scale (VAS) to rate their level of discomfort,and Constant-Murley scores (CMS) and the degree of shoulder activity were quantified in all 3 groups.Any differences in the intensity of joint mobilization were also observed.Results The VAS ratings,CMS and the degree of activity of the shoulder joint improved significantly in all three groups after the treatment.One week after the treatment,the average VAS score of group A (2.8±1) was significantly lower than that of groups B (3.8±1) and C (4.5± 1.3),but group A's average CMS (60.1±10.7) had increased to significantly more than those of groups B (48.8± 11.0) and C (44.9±9.7).At the same time,the average shoulder joint rear protraction,90° extorsion abduction,internal rotation and external rotation angles of group A were all significantly bigger than those of groups B and C.The differences were maintained until at least three months after the treatment.One week after the treatment,the intensity of the joint mnobilization of group A was significantly higher than in groups B and C,with that discrepancy also continuing until at least 3 months after the treatment.Conclusions Buprenorphine combined with joint mobilization is very effective in the treatment of periarthritis of the shoulder.It is simple,safe and elicits good patient compliance.It is worthy of pronotion among shoulder periarthritis patients.
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Objective To introduce the diagnosis and treatment of the missed adolescent humeral capitellar fracture malunion.Methods Retrospectively analyzed 6 cases with missed adolescent capitellar fracture malunion treated by the author from Jul.2010 to Mar.2015 and their follow-up results.Among them, 5 were male and 1 was female.The average age is (14.33 ± 1.86) years, 4 were left-side and 2 were right.Results The average time from injury to the operation is (8.67 ± 3.88) months.Before operation, the average elbow flexion was (91.67° ±7.53°), the average elbow extension was (40.0° ± 8.94°), the average range of flexion and extension activities was (51.67° ±11.69°).Forearm rotation was not limited.Average M EPS score was (80.83 ± 4.92).Released the elbow in 3 cases with additional medial incision.The fragment was fixed by HCS.The lateral collateral ligament was repaired by suture anchors (2 cases) or by trans-os suture(4 cases).Three cases were fixed by DJDⅡ Stryker hinged external fixatorswhich were removed after 8 weeks.The average postoperative follow-up time was (39.33 ± 20.42) months.Postoperatively, the average elbow flexion was (138.33° ±7.528°), the average elbow extension was (5.0° ± 4.472°), the average range of flexion and extension activities was (133.33° ±9.832°).Forearm rotation is not limited.The average MEPS score was 100.Conclusions The adolescent capitellar fracture is prone to be missed and cause malunion, elbow stiffness or other complications which is very difficult to deal with.By complete elbow release, osteotomy and internal fixation, the lateral collateral ligament repair, and hinged external fixator if necessary, the final elbow function can be improved.
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@#Objective To investigate the value of arthrolysis in treatment of scapulohumeral periarthritis.Methods 83 cases of scapulohumeral periarthritis were divided into arthrolysis group(45 cases), which were treated with arthrolysis combined with electrotherapy, and control group (38 cases),which were treated with electrotherapy only.Results The effect of arthrolysis group was better than that of control group (P<0.05).Conclusion Arthrolysis can improve the effect on scapulohumeral periarthritis.
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110?),5 good(90?-109?)and 1 acceptable(60?～89?)and no poor results(
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Twenty-seven consecutive patients who had post-traumatic stiffness of the elbow were treated by operative soft tissue release or by soft tissue release and distraction arthroplasty. The purpose of this study was to describe the method of operation and postoperative management and to evaluate the results in the patients who had operative treatment for the post-traumatic stiffness of the elbow. The type of operative procedure was determined by whether the factors limiting motion were extra-articular (extrinsic) or intra-articular (intrinsic) and by pre-operative radiographic evaluation. The soft tissue release was performed by staged adhesiolysis through lateral or combined lateral and medial approaches. And if the factors limiting motion included a severe intraarticular lesions, distraction arthroplasty using the Judet or Oganesian apparatus was added to soft tissue release. The mean pre-operative arc of active motion was 42 degrees. At follow-up examination, nineteen to sixty-six months postoperatively, the mean post-operative arc of active motion was 103 degrees. There were nine complications (33 percent) in twenty-seven patients. All of them was transient ulnar nerve paresthesia. And we analysed the final results with Mayo elbow performance index for the evaluation of clinical outcome. Twenty-five (93%) of twenty-seven patients had satisfactory result according to Mayo elbow performance index. We conclude arthrolysis with or without distraction arthroplasty is useful for the treatment of posttraumatic elbow stiffness. However, the accurate anatomical knowledge, operative skill, and careful postoperative rehabilitation program were needed in the operative treatment of post-traumatic elbow stiffness.
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Humans , Arthroplasty , Elbow , Follow-Up Studies , Paresthesia , Rehabilitation , Surgical Procedures, Operative , Ulnar NerveABSTRACT
High tibial osteotomy has been widely accepted as a method of treatments for middle-aged varus osteoarthritides with uncompartmental involvements. There have been several reports regarding the managements of fibula and their complications during the valgization procedure of tibia. They are, for example, osteotomy of fibular diaphysis or neck and excision of fibular head. Each level of fibular management is often complicated by nonunison, peroneal nerve palsy and lateral instability respectively. We have reviewed 20 cases of cases of high tibial osteotomy using proximal tibiofibular arthrolysis performed between March 1987 and February 1993. This method has proved excellent exposure of upper lateral tibia for the wedge removal, internal fixation and relief of the tethering effect of fibula. There was no peroneal nerve palsy relate to this degenerative change of the proximal tibiofibular was 3.4mm(range 1-11mm) and there was neither degenerative change of the proximal tibiofibular joint nor varus instability. In conclusion the arthrolysis of proximal tibiofibular joint can be highly recommended in high tibial osteotomy.
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Diaphyses , Fibula , Head , Joints , Methods , Neck , Osteoarthritis , Osteotomy , Paralysis , Peroneal Nerve , TibiaABSTRACT
Many people who sustain injuries to the femur or muscles of thigh are handicapped for life by varing degree of limitation of motion of the knee joint flexion such as squatting or kneeling. Many surgical procedures were reported by Thompson (1944), Judet (1959), van Nes (1962), Nicoll (1963), Hesketh (1963), Jahng (1965), Han (1979, 1986), and Daoud (1982). During the period from March 1987 to August 1989, 12 cases of stiff knee joint were treated surgically in our clinics. l. 12 cases of stiff knee treated by modified Judet technique of quadricepsplasty and arthrolysis. 2. The stiff knee was corrected successfully without release of rectus femoris muscle in our cases. 3. The string tie was very useful in postoperative care. String tie was applied with the knee in a full flexed position and when it was discarded, knee was extended and quadriceps setting exercise was begun. 4. In 10 cases, plate removal was added, in two eases, combined bone surgery and quadricepsplasty for malunion or nonunion of the femur, which showed good results. 5. The average flexion achieved by operation was 119.6, the average flexion gain 70.8, while the average extension gain 8.8. 6. By Judet criteria, the result of 11 cases were excellent and one case showed fair result.