Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Jiazhi ^1,2 , CHEN Shuai ² ,  FAN Cunyi ²

1. Taishan Medical University, Taian Shandong, 271016, P.R.China;
2. Department of Orthopaedics, Shanghai Sixth People’s Hospital of Eastern Hospital, Shanghai, 201306, P.R.China;

Corresponding author：

FAN Cunyi, Email: fancunyi888@163.com

Keywords：

Elbow stiffness; open release; distal radius fixation; hinge external fixation

DOI：

10.7507/1002-1892.201705102

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ObjectiveTo observe the effectiveness of open release combined with distal radius fixation hinged external fixation for the treatment of elbow stiffness.MethodsA total of 77 patients with elbow stiffness caused by trauma were enrolled in this study between October 2014 and October 2015. The patients were divided into control group (39 cases) and observation group (38 cases) by random number table method. The patients in the observation group were treated with elbow joint opening and release combined with distal radial fixation hinged external fixation, while the control group was treated with traditional release. There was no significant difference in gender, age, disease causes, original damage diagnosis, the time from injury to operation, preoperative flexion and extension activity of elbow joint, and preoperative Mayo elbow joint function score between 2 groups (P>0.05). After operation, the function of elbow joint was evaluated by the flexion and extension activity of the elbow joint and the Mayo elbow joint function evaluation standard.ResultsThe incisions healed by first intention in 2 groups. In observation group, there were 1 case infection of nail tract, 2 cases ulnar nerve symptoms, 1 case elbow ossification, and 1 case moderate pain in the elbow; while in control group, there were 2 cases of infection of nail tract, 2 cases of ulnar nerve symptoms, and 3 cases moderate pain in the elbow. The patients in 2 groups were followed up 6 weeks to 12 months, with an average of 6 months. The flexion and extension activity of elbow joint and Mayo elbow joint function score at last follow-up were significantly improved when compared with preoperative ones (P<0.05); at last follow-up, the flexion and extension activity of elbow joint and Mayo elbow joint function score in observation group patients were significantly better than those in control group (P<0.05). According to the Mayo elbow function evaluation standard, the results were excellent in 27 cases, good in 10 cases, and fair in 1 case, with an excellent and good rate of 97.4% in observation group; and the results were excellent in 12 cases, good in 21 cases, fair in 4 cases, and poor in 2 cases, with an excellent and good rate of 84.6% in control group; showing no significant difference between 2 groups (P=0.108).ConclusionOpen release combined with distal radius fixation hinged external fixation can significantly improve the elbow function of patients with traumatic elbow stiffness, its recovery of elbow function was superior to the traditional release.

Citation： LIU Jiazhi, CHEN Shuai, FAN Cunyi. Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 134-138. doi: 10.7507/1002-1892.201705102 Copy

1.	Mittal R. Posttraumatic stiff elbow. Indian J Orthop, 2017, 51(1): 4-13.
2.	Zheng W, Chen S, Song J, et al. The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness. J Shoulder Elbow Surg, 2017, 26(5): 809-814.
3.	Yu SY, Wang W, Liu S, et al. Arthrolysis and delayed internal fixation combined with hinged external fixation for elbow stiffness associated with malunion or nonunion of capitellum fracture. J Shoulder Elbow Surg, 2015, 24(6): 941-946.
4.	Panthi S, Khatri K, Kharel K, et al. Radiological and functional outcome of medial epicondyle fracture treated surgically in children and adolescents: A retrospective study. Cureus, 2017, 9(1): e953.
5.	Pettersen PM, Eriksson J, Bratberg H, et al. Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows. BMC Musculoskelet Disord, 2016, 17: 74.
6.	王华, 李少华. 肘关节僵硬治疗进展. 医学综述, 2016, 22(23): 4660-4663.
7.	Sun Y, Cai J, Li F, et al. The efficacy of celecoxib in preventing heterotopic ossification recurrence after open arthrolysis for post-traumatic elbow stiffness in adults. J Shoulder Elbow Surg, 2015, 24(11): 1735-1740.
8.	郭祁, 何大炜, 孙宁, 等. 创伤后肘关节僵硬 553 例回顾性分析. 中华外科杂志, 2015, 53(2): 85-89.
9.	Tao MJ, Probyn L, Poon M, et al. Symptomatic palliation with radiotherapy in extensive heterotopic ossifications. Ann Palliat Med, 2017, 6(Suppl 2): S260-S263.
10.	Cai J, Wang W, Yan H, et al. Complications of Open Elbow Arthrolysis in Post-Traumatic Elbow Stiffness: A Systematic Review. PLoS One, 2015, 10(9): e0138547.
11.	林光锚, 刘良乐, 叶丽洁, 等. 中医综合疗法预防肘关节三联征术后肘关节僵硬的病例对照研究. 中国骨伤, 2014, 27(11): 900-903.
12.	Zhou Y, Cai JY, Chen S, et al. Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elbow Surg, 2017, 26(2): e44-e51.
13.	Chen S, Yan H, Wang W, et al. Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows. J Shoulder Elbow Surg, 2017, 26(1): 133-139.
14.	Wang W, Zhan YL, Yu SY, et al. Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow. J Shoulder Elbow Surg, 2016, 25(5): 816-822.
15.	Wang W, Jiang SC, Liu S, et al. Stability of severely stiff elbows after complete open release: treatment by ligament repair with suture anchors and hinged external fixator. J Shoulder Elbow Surg, 2014, 23(10): 1537-1544.
16.	Ruan HJ, Liu S, Fan CY, et al. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg, 2013, 133(2): 179-185.
17.	Geiger EJ, Arzeno AH, Medvecky MJ. Hinged-Knee External Fixator Used to Reduce and Maintain Subacute Tibiofemoral Coronal Subluxation. Am J Orthop (Belle Mead NJ), 2016, 45(7): E497-E502.

1. Mittal R. Posttraumatic stiff elbow. Indian J Orthop, 2017, 51(1): 4-13.
2. Zheng W, Chen S, Song J, et al. The influence of body mass index on outcome of open arthrolysis for post-traumatic elbow stiffness. J Shoulder Elbow Surg, 2017, 26(5): 809-814.
3. Yu SY, Wang W, Liu S, et al. Arthrolysis and delayed internal fixation combined with hinged external fixation for elbow stiffness associated with malunion or nonunion of capitellum fracture. J Shoulder Elbow Surg, 2015, 24(6): 941-946.
4. Panthi S, Khatri K, Kharel K, et al. Radiological and functional outcome of medial epicondyle fracture treated surgically in children and adolescents: A retrospective study. Cureus, 2017, 9(1): e953.
5. Pettersen PM, Eriksson J, Bratberg H, et al. Increased ROM and high patient satisfaction after open arthrolysis: a follow-up-study of 43 patients with posttraumatic stiff elbows. BMC Musculoskelet Disord, 2016, 17: 74.
6. 王华, 李少华. 肘关节僵硬治疗进展. 医学综述, 2016, 22(23): 4660-4663.
7. Sun Y, Cai J, Li F, et al. The efficacy of celecoxib in preventing heterotopic ossification recurrence after open arthrolysis for post-traumatic elbow stiffness in adults. J Shoulder Elbow Surg, 2015, 24(11): 1735-1740.
8. 郭祁, 何大炜, 孙宁, 等. 创伤后肘关节僵硬 553 例回顾性分析. 中华外科杂志, 2015, 53(2): 85-89.
9. Tao MJ, Probyn L, Poon M, et al. Symptomatic palliation with radiotherapy in extensive heterotopic ossifications. Ann Palliat Med, 2017, 6(Suppl 2): S260-S263.
10. Cai J, Wang W, Yan H, et al. Complications of Open Elbow Arthrolysis in Post-Traumatic Elbow Stiffness: A Systematic Review. PLoS One, 2015, 10(9): e0138547.
11. 林光锚, 刘良乐, 叶丽洁, 等. 中医综合疗法预防肘关节三联征术后肘关节僵硬的病例对照研究. 中国骨伤, 2014, 27(11): 900-903.
12. Zhou Y, Cai JY, Chen S, et al. Application of distal radius-positioned hinged external fixator in complete open release for severe elbow stiffness. J Shoulder Elbow Surg, 2017, 26(2): e44-e51.
13. Chen S, Yan H, Wang W, et al. Reconstruction of medial collateral ligament defects with a flexor-pronator fascia patch in complete open release of stiff elbows. J Shoulder Elbow Surg, 2017, 26(1): 133-139.
14. Wang W, Zhan YL, Yu SY, et al. Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow. J Shoulder Elbow Surg, 2016, 25(5): 816-822.
15. Wang W, Jiang SC, Liu S, et al. Stability of severely stiff elbows after complete open release: treatment by ligament repair with suture anchors and hinged external fixator. J Shoulder Elbow Surg, 2014, 23(10): 1537-1544.
16. Ruan HJ, Liu S, Fan CY, et al. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg, 2013, 133(2): 179-185.
17. Geiger EJ, Arzeno AH, Medvecky MJ. Hinged-Knee External Fixator Used to Reduce and Maintain Subacute Tibiofemoral Coronal Subluxation. Am J Orthop (Belle Mead NJ), 2016, 45(7): E497-E502.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of elbow joint stiffness by open release combined with distal radius fixation hinged external fixation

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