Introduction 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 NerveMobilize 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 CapsuleDissect 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 LigamentRelease 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 CapsulePerform 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 AnteriorlyLocate 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.
Results 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.
What to Watch For Indications
Pitfalls & Challenges
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.
Joint stiffness is a well-recognized complication following trauma to the elbow. It is generally agreed that an arc of elbow flexion from 30° to …
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