Session II - Upper Extremity
Management of Post-Traumatic Elbow Arthrolysis: How to Keep the Result?
Lars-Uwe Lahoda, MD; T. Klapperich, MD; M.P. Hahn, MD; G. Muhr, MD; Chirurgische Universitätsklinik "Bergmannsheil", Bochum, Germany
Purpose: Post-traumatic restricted motion of the elbow often leads to secondary soft tissue shrinking and scarring, compromising the result; however, in postoperative treatment, immediate passive mobilization and prevention of heterotopic ossification is most important. Conservative treatment of the loss of motion results in limited success rates. Open arthrolysis is a useful tool to enable the patient to regain function following recovery from trauma.
Methods: We present the cases of 69 patients who had post-traumatic loss of motion. The joints were openly arthrolysed on average 25.3 months post-trauma. Most of the patients were operated on before, on average 1.5 times (range 0-8); the follow-up period was 14.7 months on average.
Results: Compared to the preoperative range of motion, an increase for flexion and extension of 62.3° (preoperative 38.4°, postoperative 87.9°, at follow-up 100.7°) and of 29.3° for pro- and supination was achieved by means of open arthrolysis.
Discussion: The most important arc of motion between 0-30° and 110° was accomplished in 78.2% of the patients. We analyzed the postoperative management including irradiation, pharmacological ossification prophylaxes with indomethacin and immediate passive motion. We obtained remarkably worse results whenever the time to arthrolysis exceeded 9 months. After 9 months a drop in the correlated increase of motion described by Cauchoix and Deburge from 54.3% to 34.6% was seen. The rehabilitation program is stressed and explained. Another task of this study was to discuss the complication rate.
Conclusion: Open arthrolysis of the elbow following trauma should be performed within 9 months, using continuous passive motion, irradiation and indomethacin to prevent heterotopic bone formation, to maintain the surgical result.