IntroductionOpen elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness.
Step 1: Skin Incision Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions.
Step 2: Protect or Release Peripheral Nerves Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used.
Step 3: Develop Muscle Intervals for Exposure of the Joint Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule.
Step 4: Resect Bone, Contracted Capsule, and Implants Restricting Motion Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule.
Step 5: Tenolysis/Muscle Elevation When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator.
Step 6: Manipulate Elbow; Consider Implant Removal Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants.
Step 7: Wound Closure Close the muscle intervals and skin.
Step 8: Postoperative Management The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches.
Results A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°.
What to Watch For Indications
Pitfalls & Challenges
Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness.
The elbow is notorious …
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