Session III - Upper Extremity
Fri., 10/8/04 Upper Extremity, Paper #19, 3:25 pm
The Effectiveness of Static Progressive Splinting for Post-Traumatic Elbow Stiffness
Purpose: Elbow stiffness is one of the most common complications of elbow trauma. When exercises fail to restore motion, surgery is considered. A program of static progressive splinting is often used in an attempt to avoid surgery when a standard exercise program is no longer improving motion. It remains unclear how often splinting obviates the need for surgery.
Methods: Over a 3-year period, 21 consecutive patients with a posttraumatic elbow contracture were treated with static progressive elbow splinting after a standard exercise program was no longer achieving gains in motion. The initial injury was a fracture of the distal humerus in eight patients, the radial head in seven patients, the olecranon in four patients, with associated radial head and distal humerus fractures in one, a Monteggia fracture in one, and a simple dislocation of the elbow in one patient. Two patients were treated after the injury alone, 11 were treated after operative treatment of the initial injury, 7, after operative contracture release, and 1 patient was treated with static progressive splinting after a total elbow arthroplasty. Splinting was initiated an average of 39 days after injury alone or 50 days after operative treatment.
Results: The flexion arc improved from 71° (45° to 115°) prior to splinting to 113° (range, 40° to 150°) after splinting. Prior to the initiation of splinting, only three (14%) patients had a functional arc of motion (defined as 30° to 130° of splinting). After splinting, 15 (71%) of 21 patients had a functional arc of motion. Only two patients ultimately requested an elbow contracture release to attempt to gain additional motion.
Conclusion: Static progressive splinting can help gain additional motion when standard exercises prove inadequate. Operative treatment was avoided in more than three-fourths of patients.