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Objective:To study the locational distribution characteristics of the heterotopic ossification (HO) following traumatic elbow stiffness and the risk factors for HO development at different locations.Methods:Consecutively included according to our inclusion criteria in the present study were the patients who had been admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from January 2018 to December 2018 for elbow release due to traumatic elbow stiffness but developed postoperative HO. Their baseline data and CT data were collected and processed using Mimics 20.0. The HO distribution for each patient was characterized at the anteromedial, anterolateral, posteromedial, posterolateral, posterior, medial, lateral, and proximal radioulnar locations. The patient's original injury was categorized into 5 types: distal humerus fracture, olecranon fracture, radial head fracture, coronoid fracture, and elbow dislocation. After the univariate analysis with the HO occurrence at a specific location as the dependent variable and the original injury and baseline data as the independent variables, the factors with P value less than 0.1 were included in the logistic regression analysis to determine the risk factors for HO at each location.Results:A total of 91 patients were included in this study. Of them, 88 had posteromedial HO (96.7%, 88/91), 62 posterior HO (68.1%, 62/91), 60 posterolateral HO (65.9%, 60/91), 41 anteromedial HO (45.1%, 41/91), 26 anterolateral HO (28.6%, 26/91), 13 proximal radioulnar HO (14.3%, 13/91), 8 lateral HO (8.8%, 8/91), and 7 medial HO (7.7%, 7/91). Logistic regression analysis showed that presence of ulnar nerve symptoms ( OR=4.354, P=0.017) and presence of original elbow dislocation ( OR=2.927, P=0.042) were the independent risk factors for the anteromedial HO development and that presence of original olecranon fracture ( OR=0.277, P=0.023) was the protective factor for the anteromedial HO development. Presence of original radial head fracture was the independent risk factor for the anterolateral HO development ( OR=2.891, P=0.033) and the posterolateral HO development ( OR=3.123, P=0.043). Conclusions:HO development in patients with post-traumatic elbow stiffness is closely related to their original injury. Posteromedial HO may develop in almost all the patients. Patients with ulnar nerve symptoms and original elbow dislocation are more prone to anteromedial HO development, but patients with original olecranon fracture are less likely to develop anteromedial HO. Patients with original radial head fracture are more likely to develop anterolateral and posterolateral HO.
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Objective To investigate the feasibility of adding an auxiliary soft-point portal for the arthroscopic treatment of stiff elbow.Methods From January 2016 to August 2017,20 patients with stiff elbow were treated at Department of Orthopaedic Surgery,The Second Affiliated Hospital to Nanchang University.They were 13 males and 7 females,with a mean age of 30.8 years (from 18 to 46 years).Their elbow stiffness time averaged 8.4 months (from 6 to 14 months).Their stiff elbow was released by elbow arthroscopy after their surgical contraindications were controlled.In addition to conventional portals,an auxiliary soft-point portal was used.Analgesia was conducted postoperatively and staged rehabilitation encouraged immediately after operation.The therapeutic effects were evaluated using Hospital for Special Surgery (HSS) elbow score and the Mayo scoring system at final follow-ups.Results The 20 patients were followed up for an average time of 8.9 months (from 4 to 15 months).Their preoperative maximum elbow flexion (62.3°±21.4°),maximum elbow extension (30.4° ± 13.6°) and total range of elbow motion (32.5° ± 22.4°) were significantly improved to 112.6° ± 23.4°,15.3° ± 10.4° and 98.4° ± 15.3°,respectively,at final follow-ups (P ＜0.05).According to their HSS elbow scores,13 cases were excellent and 7 good,yielding an excellent to good rate of 100％;their preoperative Mayo scores (64.1 ± 12.8) were significantly improved to 85.6 ± 7.4 points at final follow-ups (P ＜ 0.05).Conclusion Addition of an auxiliary soft-point portal in the arthroscopic treatment of elbow stiffness can simplify operative maneuver and shorten operation time,leading to fine curative efficacy.
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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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A 42 years old female presented with the complaints of pain and stiffness of right elbow with limited elbow extension, since 8 months, due to fracture of head of the radius. She was receiving conventional physical therapy treatment for pain relief and functional improvement since eight months. The limitation in Elbow extension caused difficulty in carrying household works. Later the patient was treated with dry needling to myofascial trigger points in brachioradiallis, common flexor, and extensor muscles of elbow and upper trapezius of shoulder, dry needling for tendons were added for further muscle relaxation. The interventions were carried out for three sessions, alternatively for one week. Pain (VAS score from 8/10 to 1/10), elbow extension range of motion (from 120º -35º to 120º-05º) and the patient’s upper limb functions (Qu ick DASH score from 63.36 to 13.63) were improved after one week of intervention. This case report results suggest that overall neuro-musculoskeletal function was improved due to dry needle induced myofascial trigger points deactivation and further muscle relaxation caused by tendon needling. This case report may helpful in formulating further treatment tool for better and faster recovery from pain and joint dysfunction in post immobilization pain and stiffness of elbow and other joints.
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Objective To compare the posterior midline approach and the combined lateral and medial approach usually used in elbow arthrolysis. Methods From January to December in 2009, 41 cases of elbow stiffness were treated and fully followed up by the same team in our hospital. The posterior midline approach was used in 21 cases, 15 males and 6 females, with an average age of 35.8 years (16 to 70 years). In this group, the total flexion-extension arc was ＜ 30° in 12 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Eight cases had ulnar symptoms. The combined lateral and medial approach was applied in 20 cases, 8 males and 12 females, with an average age of 38. 8 years (16 to 51 years). In this group, the total flexion-extension arc was ＜ 30° in 11 cases, 31° to 60° in 7 cases, and 61° to 90° in 2 cases. Five cases had ulnar symptoms. Results The 41 cases were followed up for 4 to 15 months (average, 7.9 months). In the posterior approach group, the mean preoperative flexion-extension ROM (27.6°± 25.7°) was improved to the postoperative 111.4°± 25.6°, the mean preoperative rotation ROM ( 152.9°± 46. 9°) to the postoperative 168.1°± 19. 1°, and the mean preoperative MEPS score (65.5 ± 11.5) to the postoperative 95.7 ±6.4. In the combined approach group, the mean flexion-extension ROM was improved from 35.5°± 25.0° preoperatively to 116. 5°± 19.1° postoperatively, the mean rotation ROM from 138.0°±55.7° preoperatively to 148.5°± 45.6° postoperatively, and the mean MEPS score from 66. 3 ± 13.0 preoperatively to 97.3 ± 7.0 postoperatively. The differences were statistically significant between preoperation and postoperation in both groups ( P ＜ 0. 05), but not statistically different between the 2 groups in the preoperative or postoperative values ( P ＞ 0. 05). In the posterior approach group, 5 patients had huge hematoma, 3 had wound dehiscence at the posterior elbow, and the others all had mild hematoma. But in the combined approach group, no wound complications were noted. Conclusion The combined lateral and medial approach should be used as far as possible in the elbow arthrolysis to avoid the likely complications when the posterior midline approach is used.
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Objective To investigate simple manual humeroulnar distraction for alleviating elbow stiffness due to upper limb fracture. Methods Twenty-seven patients with elbow stiffness due to upper limb fracture were divided into control and experimental groups. Before treatment there was no significant difference in stiffness between the groups. The controls were treated with the combined mobilizations and passive stretching. The experimental group was treated with manual humeroulnar distraction alone. Both groups were treated for four weeks. Range of motion ( ROM) and the Mayo elbow function scale (MEFS) were used to evaluate elbow function before and after 4 weeks of treatment. Results After 4 weeks, there was a significant difference between the groups. In the experimental group average ROM reached (110±20) °,an average of 29.6°better than the controls (80.4±23.6) °. MEFS scores also showed significant differences between the experimental group (93. 85±7. 95) and the control group (83.93±9. 24). Conclusions Humeroulnar joint distraction might increase ROM and improve the functioning of stiff elbow joints. This finding may help rehabilitation professionals choose more effective manual mobilization techniques for treating elbow stiffness after upper limb fracture.
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@#ObjectiveTo evaluate the significance of flexion priority strategy and the principle of joint mobilization technique in the rehabilitation of posttraumatic stiffness of the elbow. Methods24 patients with posttraumatic stiffness of the elbow were divided into 2 groups, 12 patients in each group. The treatment group was treated with flexion priority strategy of joint mobilization technique only in the treatment of flexion contracture. In order to decrease the pain caused by joint mobilization training of extension and achieve the restoration of flexion as early as possible, the rehabilitation of extension was altered to self-exercise under the consultation of doctors combined with gentle passive traction by the therapist. The control group was treated with joint mobilization technique of both flexion and extension once a day. All the patients were measured the flexion range, extension range, and flexion-extension arc after 6 weeks of rehabilitation. Results6 weeks after rehabilitation, the treatment group got 124° of flexion (range 95°～135°), much better than the control group of 95° (range 80°～110°) （P<0.01）. There was no significant difference of extension degrees between the treatment group (15°, range 10°～35°) and the control group (16°, range 10°～30°) （P＞0.05）. The final arc of flexion and extension in the treatment group had an increase of 53°, significantly greater than 30° in the control group（P<0.01）. ConclusionFlexion priority strategy of elbow rehabilitation can significantly restore the flexion function of posttraumatic elbow stiffness.
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@# Elbow stiffness is a common complication after trauma or surgery to this joint. The soft tissue is a primary factor resulting in stiffness of the elbow. Splints increasing passive range of motion (PROM) with creep or stress relaxation principle play a important role in reconstruction for post-traumatic elbow stiffness. The clinician should follow the basic principle in designing and application of splints. With reasonable resign and appropriate regimen, clinical experience and related research show that splints can improve elbow ROM of post-traumatic elbow stiffness efficiently.