Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach / Tratamento cirúrgico da rigidez pós-traumática do cotovelo por via posterior ampla

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.

Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.

Resection Arthroplasty for the Treatment of Joint Stiffness after Dislocation of the Four Lateral Lesser Metatarsophalangeal Joints (A Case Report) / 대한족부족관절학회지

Motion of the metatarsophalangeal joints is essential for the normal gait. Therefore it is important to recover the motion of normal joint in the treatment of stiffness of the metatarsophalangeal joints. However, there have been no report about the treatment of stiffness of the four lateral lesser metatarsophalangeal joints yet. We report an experience that good clinical and radiographic results were obtained after resection arthroplasty for the post-traumatic stiffness of the four lateral lesser metatarsophalangeal joints.

Surgical Treatment of Post-traumatic Elbow Stiffness / 대한정형외과학회잡지

PURPOSE: We analyzed the clinical results of surgical treatment in patients with post-traumatic stiff elbow. MATERIALS AND METHODS: We performed surgical release in 22 elbows with posttraumatic stiffness of extraarticular origin. The average preoperative arc was 48.3 degrees, with an average flexion contracture of 39.5 degrees and an average further flexion of 87.2 degrees. Depending on their radiographic findings, cases were divided on the basis of whether ectopic ossification was present (16 cases) or not (6 cases); and as to whether the articular surface was involved (11 cases) or not (11 cases). The postoperative final arc and ratio of desired gain were compared between the groups. RESULTS: The average final arc was 108.9 degrees in the ectopic ossification group and 85.7 degrees in the non-ectopic ossification group, and showed a significantly higher arc in the ectopic ossification group. The ratios of desired gain were 89.3% and 62.6%, respectively, being significantly higher in the ectopic ossification group. In terms of articular surface involvement, no significant difference was observed between the two groups. CONCLUSION: When performing operative treatment for post-traumatic stiff elbow, assessment of the cause plays an important role. In case of ectopic ossification, satisfactory results can be expected with operative treatment after the ectopic bone has matured.

Arthroscopic Treatment for Limitation of Motion of the Elbow Joint / 대한정형외과학회잡지

PURPOSE: To describe long-term clinical results and serial changes in the postoperative range of motion (ROM) after arthroscopic treatment for a limitation of motion (LOM) of the elbow. MATERIALS AND METHODS: Sixty-three patients with LOM of the elbow were treated with arthroscopic procedures. The follow-up period averaged 42.5 months. RESULTS: The total ROM was 79.3degrees C preoperatively. From the first and second week after the operation, the ROM showed a progressive increase up to six months postoperatively (mean 109.2degrees C at 3 months and mean 118.4degrees C at 6 months follow-up). Then the ROM continued to increase slowly for a total of 1 year after the operation (mean 121.5degrees C). However, after one year postoperative, the ROM showed little further increase. The ROM acquired during surgery (mean 121.9degrees C) was usually the same range achieved by patients during the rehabilitation period (mean 122.8degrees C at an average of 42.5 months follow-up). Patients with post-traumatic stiffness had more severe flexion contracture and decreased total ROM (73.1degrees C) than those with degenerative stiffness (85.7degrees C) preoperatively. But no significant difference existed in the postoperative total ROM (post-traumatic stiffness, 122.8degrees C and degenerative stiffness, 120.5degrees C). CONCLUSION: Based on our experience, 94% of the patients obtained functional ROM after arthroscopic procedures. The minimally invasive nature of elbow arthroscopy is a safe, reproducible and effective procedure for LOM of the elbow with minimal morbidity.