[Technical modifications to elbow interposition arthroplasty].

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Abstract

[Indexed for MEDLINE] 18. JBJS Essent Surg Tech. 2011 Oct 26;1(3):e18. doi: 10.2106/JBJS.ST.K.00010. eCollection 2011 Oct. Operative Treatment of Elbow Stiffness. Ring D(1), Jupiter JB(1). Author information: (1)Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, 55 Fruit Street, Boston MA 02114. E-mail address for D. Ring: dring@partners.org. INTRODUCTION: Open 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: IndicationsContraindicationsPitfalls & Challenges. DOI: 10.2106/JBJS.ST.K.00010 PMCID: PMC6554076