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Surgical Release for Posttraumatic Loss of Elbow Flexion
Min Jong Park, MD1; Moon Jong Chang, MD1; Yong Beom Lee, MD2; Hong Je Kang, MD3
1 Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Republic of Korea. E-mail address for M.J. Park: mjp3506@skku.edu
2 Department of Orthopedic Surgery, Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyungchon-dong, Dongan-gu, Anyang, Republic of Korea
3 Department of Orthopaedic Surgery, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Jeollabuk-do, Republic of Korea
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Based on an original article: J Bone Joint Surg Am. 2010;92:2692-9.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2011 Nov 23;01(03):e16 1-8. doi: 10.2106/JBJS.ST.K.00008
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We describe a surgical release for patients who have a lack of elbow flexion limiting the ability to perform activities of daily living after trauma.

Step 1: Mobilize the Ulnar Nerve

Mobilize the ulnar nerve through the cubital tunnel with the accompanying superior ulnar collateral vessels.

Step 2: Dissect the Triceps and Resect the Posterior Aspect of the Capsule

Dissect the triceps from the distal part of the humerus and resect the posterior aspect of the capsule to expose the olecranon tip and fossa.

Step 3: Resect the Posterior Band of the Medial Collateral Ligament

Release the posterior band of the medial collateral ligament while continually checking the flexion arc until >130° of flexion can be achieved.

Step 4: Resect the Anterior Aspect of the Capsule

Perform an anterior approach if there is persistent flexion contracture or any impingement restricting full flexion.

Step 5: Lengthen the Triceps If Indicated

Consider triceps lengthening if you cannot achieve >130° of passive flexion with two fingers.

Step 6: Transpose the Ulnar Nerve Anteriorly

Locate the released ulnar nerve over the medial humeral epicondyle on the fascia overlying the common flexor-pronator muscles.

Step 7: Postoperative Management

Physical therapy consists of active-assisted and gentle passive flexion and extension exercises of the elbow, usually for two to six months.


Forty-two patients with <100° of elbow flexion as an extrinsic contracture following trauma had a surgical release of the elbow at a median of ten months postinjury.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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