RESUMO
OBJECTIVE: To evaluate the results from surgical treatment of posttraumatic stiffness of the elbow in skeletally mature patients. METHODS: Between October 2000 and October 2007, 45 elbows of 45 patients underwent surgical treatment performed by the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Ten patients were treated arthroscopically and the remainder by open surgery. The minimum follow-up was six months, with a mean of 22 months. Their ages ranged from 17 to 72 years, with a mean of 36 years and three months. Males predominated, accounting for 60% of the cases. The dominant limb was involved in 56.5% of the cases. The clinical evaluation of the results was done by using the criteria of the American Medical Association (AMA), as modified by Bruce; the Mayo Elbow Performance Score (MEPS); and measurements on the gain of flexion-extension arc and the final range of motion. RESULTS: According to the AMA criteria, as modified by Bruce, 42.2% of our results were satisfactory, whereas 77.8% were satisfactory according to MEPS. The mean postoperative flexion-extension arc was 106°, and the main gain in range was 46°. The evaluation of the variables showed that patients with an initial flexion arc greater than 90° achieved a greater final flexion-extension arc, and those with an initial extension less than or equal to 60° gained greater range of motion. CONCLUSION: Surgical treatment of posttraumatic stiffness of the elbow in skeletally mature individuals was shown to be satisfactory according to MEPS, but unsatisfactory according to AMA. We observed that the patients with preoperative flexion greater than 90° evolved with a greater flexion-extension arc after surgical treatment, while those who had contracture with extension less than or equal to 60° gained a greater range of motion.
RESUMO
OBJETIVO: Avaliar os resultados do tratamento cirúrgico da rigidez pós-traumática do cotovelo em pacientes esqueleticamente maturos. MÉTODOS: Entre outubro de 2000 e outubro de 2007, 45 cotovelos de 45 pacientes foram submetidos a tratamento cirúrgico pelo Grupo de Cirurgia de Ombro e Cotovelo do Departamento de Ortopedia e Traumatologia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Dez pacientes foram tratados por via artroscópica e o restante por via aberta. O seguimento mínimo foi de seis meses, com média de 22 meses. A idade variou de 17 a 72 anos, com média de 36 anos e três meses. Houve predomínio do sexo masculino em 60 por cento dos casos. O membro dominante foi acometido em 56,5 por cento. A avaliação clínica dos resultados foi feita pelos critérios da American Medical Association (AMA), modificada por Bruce, e os do Mayo Elbow Performance Score (MEPS), além da mensuração do ganho do arco de flexoextensão e do arco final de movimento. RESULTADOS: Pelos critérios de AMA, modificados por Bruce, obtivemos 42,2 por cento de resultados satisfatórios, contra 77,8 por cento pelos de MEPS. O arco de flexoextensão médio pós-operatório foi de 106º, e média de ganho de amplitude de 46º. A avaliação das variáveis mostrou que pacientes com flexão inicial maior que 90º obtiveram arco de flexoextensão final maior e, aqueles com extensão inicial menor ou igual a 60º ganharam maior arco de movimento. CONCLUSÃO: O tratamento cirúrgico da rigidez pós-traumática do cotovelo em indivíduos esqueleticamente maturos mostrou-se satisfatório pelo método de avaliação do MEPS, mas insatisfatório pelo da AMA. Observamos que os pacientes com flexão maior que 90º no período pré-operatório evoluíram com arco de flexoextensão maior após o tratamento cirúrgico, enquanto que os que tinham contratura com extensão menor ou igual a 60º ganharam maior arco de movimento.
OBJECTIVE: To evaluate the surgical treatment of posttraumatic stiffness of the elbow in skeletally mature patients. METHODS: Between October 2000 and October 2007, 45 elbows of 45 patients underwent surgical treatment by the Shoulder and Elbow Surgery Group, Department of Orthopedics and Traumatology, Faculty of Medical Sciences of the Santa Casa de São Paulo. Ten patients were treated by arthroscopy and the remainder by open surgery. Minimum follow-up was six months, with an average of 22 months. Age ranged from 17 to 72 years, with a mean of 36 years and three months. Male were predominant, accounting for 60 percent of cases. The dominant limb was involved in 56.5 percent of cases. Clinical evaluation of the results was done by the criteria of the American Medical Association (AMA), modified by Bruce, the Mayo Elbow Performance Score (MEPS), and by measuring the gain of the flexo-extension arc and the final range of movement. RESULTS: According to the AMA criteria, modified by Bruce, we have obtained satisfactory results of 42.2 percent, in contrast to 77.8 percent according to the MEPS. The mean postoperative arc of flexo-extension was 106º, with a 46º mean range gain. The evaluation of the variables showed that patients with an initial flexion arc greater than 90º obtained higher end flexo-extension, and those with an initial extension less than or equal to 60º gained a greater range of motion. CONCLUSION: Surgical treatment of posttraumatic stiffness of the elbow in skeletally mature individuals was satisfactory for the MEPS, but poorly according to the AMA. We observed that patients with flexion greater than 90º preoperatively evolved with a higher arc of flexo-extension after surgical treatment, while those who had extension contracture of less than or equal to 60º gained a wider range of motion.
