Binocular loupe assisted mini-lateral and medial incisions in lateral position for release of elbow stiffness_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Hongru ¹ , ZHONG Zhenjia ² , ZHANG Zitao ¹ , WANG Yichong ² , ZHU Zezhang ¹ , QIU Yong ¹ ,  LI Fengfeng ¹

1. Department of Orthopedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing Jiangsu, 210008, P. R. China;
2. Department of Orthopedics, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510245, P. R. China;

Corresponding author：

LI Fengfeng, Email: fengmale@163.com

Keywords：

Elbow stiffness; elbow joint release; minimally invasive; ulnar nerve injury

DOI：

10.7507/1002-1892.202311017

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Objective To analyze the effectiveness of binocular loupe assisted mini-lateral and medial incisions in lateral position for the release of elbow stiffness. Methods The clinical data of 16 patients with elbow stiffness treated with binocular loupe assisted mini-internal and external incisions in lateral position release between January 2021 and December 2022 were retrospectively analyzed. There were 9 males and 7 females, aged from 19 to 57 years, with a median age of 33.5 years. Etiologies included olecranon fracture in 6 cases, elbow dislocation in 4 cases, medial epicondyle fracture in 2 cases, radial head fracture in 4 cases, terrible triad of elbow joint in 2 cases, supracondylar fracture of humerus in 1 case, coronoid process fracture of ulna in 1 case, and humerus fracture in 1 case, with 5 cases presenting a combination of two etiologies. The duration of symptoms ranged from 5 to 60 months, with a median of 8 months. Preoperatively, 12 cases had concomitant ulnar nerve numbness, and 6 cases exhibited ectopic ossification. The preoperative range of motion for elbow flexion and extension was (58.63±22.30)°, the visual analogue scale (VAS) score was 4.3±1.6, and the Mayo score was 71.9±7.5. Incision lengths for both lateral and medial approaches were recorded, as well as the occurrence of complications. Clinical outcomes were evaluated using Mayo scores, VAS scores, and elbow range of motion both preoperatively and postoperatively. Results The lateral incision lengths for all patients ranged from 3.0 to 4.8 cm, with an average of 4.1 cm. The medial incision lengths ranged from 2.4 to 4.2 cm, with an average of 3.0 cm. The follow-up duration ranged from 6 to 19 months and a mean of 9.2 months. At last follow-up, 1 patient reported moderate elbow joint pain, and 3 cases exhibited residual mild ulnar nerve numbness. The other patients had no complications such as new heterotopic ossification and ulnar nerve paralysis, which hindered the movement of elbow joint. At last follow-up, the elbow range of motion was (130.44±9.75)°, the VAS score was 1.1±1.0, and the Mayo score was 99.1±3.8, which significantly improved when compared to the preoperative ones (t=−12.418, P<0.001; t=6.419, P<0.001; t=−13.330, P<0.001). Conclusion The binocular loupe assisted mini-lateral and medial incisions in lateral position integrated the advantages of traditional open and arthroscopic technique, which demonstrated satisfying safety and effectivity for the release of elbow contracture, but it is not indicated for patients with posterior medial heterolateral heterotopic ossification.

Citation： MA Hongru, ZHONG Zhenjia, ZHANG Zitao, WANG Yichong, ZHU Zezhang, QIU Yong, LI Fengfeng. Binocular loupe assisted mini-lateral and medial incisions in lateral position for release of elbow stiffness. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(2): 140-144. doi: 10.7507/1002-1892.202311017 Copy

1.	Evans PJ, Nandi S, Maschke S, et al. Prevention and treatment of elbow stiffness. J Hand Surg (Am), 2009, 34(4): 769-778.
2.	Attum B, Obremskey W. Posttraumatic elbow stiffness: A critical analysis review. JBJS Rev, 2016, 4(9): e1.
3.	Siemensma MF, van der Windt AE, van Es EM, et al. Management of the stiff elbow: a literature review. EFORT Open Rev, 2023, 8(5): 351-360.
4.	仲飙, 张弛, 罗从风, 等. 肘关节“恐怖三联征”中内侧副韧带及合并损伤的治疗策略. 中华骨科杂志, 2013, 33(5): 534-540.
5.	张弛, 仲飙, 罗从风, 等. 外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效. 中华骨科杂志, 2015, 35(4): 320-327.
6.	Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg (Am), 1981, 63(6): 872-877.
7.	Guglielmetti CLB, Gracitelli MEC, Assunção JH, et al. Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation. J Shoulder Elbow Surg, 2020, 29(8): 1522-1529.
8.	Kung TA, Jebson PJL, Cederna PS. An individualized approach to severe elbow burn contractures. Plast Reconstr Surg, 2012, 129(4): 663e-673e.
9.	Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg (Am), 1990, 72(4): 601-618.
10.	Kruse KK, Papatheodorou LK, Weiser RW, et al. Release of the stiff elbow with mini-open technique. J Shoulder Elbow Surg, 2016, 25(3): 355-361.
11.	Streubel PN, Cohen MS. Open surgical release for contractures of the elbow. J Am Acad Orthop Surg, 2015, 23(6): 328-338.
12.	Brinsden MD, Carr AJ, Rees JL. Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach. J Orthop Surg Res, 2008, 3: 39.
13.	Aldridge JM, Katt B, Rizzo M, et al. Anterior elbow release for post-traumatic flexion contractures in patients 21 years or younger. J Shoulder Elbow Surg, 2020, 29(7): 1394-1400.
14.	Bręborowicz M, Lubiatowski P, Długosz J, et al. The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases. Int Orthop, 2014, 38(3): 561-567.
15.	Higgs ZC, Danks BA, Sibinski M, et al. Outcomes of open arthrolysis of the elbow without post-operative passive stretching. J Bone Joint Surg (Br), 2012, 94(3): 348-352.
16.	Sharma S, Rymaszewski LA. Open arthrolysis for post-traumatic stiffness of the elbow: results are durable over the medium term. J Bone Joint Surg (Br), 2007, 89(6): 778-781.
17.	Hall AT, Paul RW, Lencer A, et al. Incidence of repeat elbow capsular release after arthroscopic elbow capsular release. Orthop J Sports Med, 2023, 11(8): 23259671231190381.
18.	Batko BD, Hakakian D, Norin JL, et al. Complications in elbow arthroscopy: Management and prevention. Sports Med Arthrosc Rev, 2022, 30(1): 54-62.

1. Evans PJ, Nandi S, Maschke S, et al. Prevention and treatment of elbow stiffness. J Hand Surg (Am), 2009, 34(4): 769-778.
2. Attum B, Obremskey W. Posttraumatic elbow stiffness: A critical analysis review. JBJS Rev, 2016, 4(9): e1.
3. Siemensma MF, van der Windt AE, van Es EM, et al. Management of the stiff elbow: a literature review. EFORT Open Rev, 2023, 8(5): 351-360.
4. 仲飙, 张弛, 罗从风, 等. 肘关节“恐怖三联征”中内侧副韧带及合并损伤的治疗策略. 中华骨科杂志, 2013, 33(5): 534-540.
5. 张弛, 仲飙, 罗从风, 等. 外侧入路联合前内侧入路治疗肘关节“恐怖三联征”的手术疗效. 中华骨科杂志, 2015, 35(4): 320-327.
6. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg (Am), 1981, 63(6): 872-877.
7. Guglielmetti CLB, Gracitelli MEC, Assunção JH, et al. Randomized trial for the treatment of post-traumatic elbow stiffness: surgical release vs. rehabilitation. J Shoulder Elbow Surg, 2020, 29(8): 1522-1529.
8. Kung TA, Jebson PJL, Cederna PS. An individualized approach to severe elbow burn contractures. Plast Reconstr Surg, 2012, 129(4): 663e-673e.
9. Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg (Am), 1990, 72(4): 601-618.
10. Kruse KK, Papatheodorou LK, Weiser RW, et al. Release of the stiff elbow with mini-open technique. J Shoulder Elbow Surg, 2016, 25(3): 355-361.
11. Streubel PN, Cohen MS. Open surgical release for contractures of the elbow. J Am Acad Orthop Surg, 2015, 23(6): 328-338.
12. Brinsden MD, Carr AJ, Rees JL. Post-traumatic flexion contractures of the elbow: Operative treatment via the limited lateral approach. J Orthop Surg Res, 2008, 3: 39.
13. Aldridge JM, Katt B, Rizzo M, et al. Anterior elbow release for post-traumatic flexion contractures in patients 21 years or younger. J Shoulder Elbow Surg, 2020, 29(7): 1394-1400.
14. Bręborowicz M, Lubiatowski P, Długosz J, et al. The outcome of open elbow arthrolysis: comparison of four different approaches based on one hundred cases. Int Orthop, 2014, 38(3): 561-567.
15. Higgs ZC, Danks BA, Sibinski M, et al. Outcomes of open arthrolysis of the elbow without post-operative passive stretching. J Bone Joint Surg (Br), 2012, 94(3): 348-352.
16. Sharma S, Rymaszewski LA. Open arthrolysis for post-traumatic stiffness of the elbow: results are durable over the medium term. J Bone Joint Surg (Br), 2007, 89(6): 778-781.
17. Hall AT, Paul RW, Lencer A, et al. Incidence of repeat elbow capsular release after arthroscopic elbow capsular release. Orthop J Sports Med, 2023, 11(8): 23259671231190381.
18. Batko BD, Hakakian D, Norin JL, et al. Complications in elbow arthroscopy: Management and prevention. Sports Med Arthrosc Rev, 2022, 30(1): 54-62.

Chinese Journal of Reparative and Reconstructive Surgery

Binocular loupe assisted mini-lateral and medial incisions in lateral position for release of elbow stiffness

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