Open versus Arthroscopic Treatment of Post-Traumatic Stiff Elbow

Ahmed Mohamed Ahmed Othman

Department of Orthopedic Surgery, El-Minia University, El-Minia, Egypt.

DOI: 10.4236/ojo.2014.411047                

Abstract

Thirty three patients with post-traumatic stiff elbow were divided into two groups. The first group included 18 patients with an average age of 31.05 years treated by open arthrolysis. The second included 15 patients with an average age of 31.66 years treated by arthroscopic method. The results were evaluated using the Mayo clinic score and DASH score for elbow function. In the open group, after an average period of follow-up 19.33 months, the average range of flexion-extension movement improved from 51.11° to 103.94°. The average Mayo clinic score improved from 63.38 to 92.83 and the average DASH score improved from 68.1 to 40.23. There were 13 cases (72.22%) excellent, 4 cases (22.22%) good and 1 case (5.55%) with the poor result. In the arthroscopic group, after an average period of follow-up 17.73 months, the average range of flexion-extension movement improved from 59.46° to 101.53°. The average Mayo clinic score improved from 62.93 to 92.73 and the average DASH score improved from 69.25 to 46.4. There were 10 cases (66.66%) excellent, 3 cases (20%) good and 2 cases (13.33%) with the poor result. Both open and arthro-scopic treatment can be effective in treatment of post-traumatic stiff elbow. Arthroscopic treatment is associated with less post-operative pain and morbidity. However, open treatment provides better range of motion and marked improvement of elbow function.

Keywords

Post-Traumatic Stiff Elbow, Open Arthrolysis, Arthroscopic Treatment, Mayo Clinic Performance Score, DASH Score

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	O’Driscoll, G., Yamaguchi, K., King, S. and McKee, M. (2007) Arthroscopic Osteocapsular Arthroplasty. In: Advanced Reconstruction Elbow, Vol. 16, American Academy of Orthopaedic Surgeons, Rosemont.
[2]	Morrey, B.F., Askew, L.J., An, K.N. and. Chao, E.Y. (1981) A Biomechanical Study of Normal Functional Elbow Motion. Journal of Bone and Joint Surgery—Series A, 63, 872-877.
[3]	Sojbjerg, J.O. (1996) The Stiff Elbow. Acta Orthopaedica Scandinavica, 67, 626-631. http://dx.doi.org/10.3109/17453679608997771
[4]	Morrey, B.F. (1990) Post-Traumatic Contracture of the Elbow. Operative Treatment, Including Distraction Arthroplasty. Journal of Bone and Joint Surgery (A), 72, 601-618.
[5]	Jupiter, J.B., O’Driscoll, S.W. and Cohen, M.S. (2003) The Assessment and Management of the Stiff Elbow. Instructionalcourse lectures, 52, 93-111.
[6]	Peden, J.P. and Savoie, F.H. (2006) Arthroscopy of the Stiff Elbow. Techniques in Orthopaedics, 21, 331-339. http://dx.doi.org/10.1097/01.bto.0000252138.82801.e1
[7]	Blonna, D., Bellato, E., Marini, E., Scelsi, M. and Castoldi, F. (2011) Arthroscopic Treatment of Stiff Elbow. International Scholarly Research Network, 2011, Article ID: 378135, 7 p.
[8]	Nowicki, K.D. and Shall, L.M. (1992) Arthroscopic Release of a Posttraumatic Flexion Contracture in the Elbow: A Case Report and Review of the Literature. Arthroscopy, 8, 544-547. http://dx.doi.org/10.1016/0749-8063(92)90024-6
[9]	Jones, G.S. and Savoie, F.H. (1993) Arthroscopic Capsular Release of Flexion Contractures (Arthrofibrosis) of the Elbow. Arthroscopy, 9, 277-283. http://dx.doi.org/10.1016/S0749-8063(05)80422-0
[10]	Strobel, M.J., Eckardt, O.A. and Eichhorn, H.J. (2001) Arthroscopic Therapy in Limited Mobility of the Elbow Joint. Der Orthopade, 30, 610-618. http://dx.doi.org/10.1007/s001320170048
[11]	Redden, J.F. and Stanley, D. (1993) Arthroscopic Fenestration of the Olecranon Fossa in the Treatment of Osteoarthritis of the Elbow. Arthroscopy, 9, 14-16. http://dx.doi.org/10.1016/S0749-8063(05)80337-8
[12]	McLaughlin II, R.E., Savoie, F.H., Field, L.D. and Ramsey, J.R. (2006) Arthroscopic Treatment of the Arthritic Elbow Due to Primary Radiocapitellar Arthritis. Arthroscopy, 22, 63-69. http://dx.doi.org/10.1016/j.arthro.2005.10.013
[13]	Morrey, B., An, K. and Chao, E. (1993) Functional Evaluation of the Elbow. In: Morley, B.F., Ed., The Elbow and Its Disorders, 2nd Edition, WB Saunders, Philadelphia, 86-97.
[14]	Nandi, S., Maschke, S., Evans, P.J. and Lawton, J.N. (2009) The Stiff Elbow. Journal of Hand Surgery, 4, 368-379.
[15]	Chammas, M. (2014) Post-Traumatic Osteoarthritis of the Elbow. Orthopaedics and Traumatology: Surgery & Research, 100, S15-S24.
[16]	Kodde, I.F., van Rijn, J., van den Bekerom, M.P. and Eygendaal, D. (2013) Surgical Treatment of Post-Traumatic Elbow Stiffness: A Systematic Review. Journal of Shoulder and Elbow Surgery, 22, 574-580. http://dx.doi.org/10.1016/j.jse.2012.11.010
[17]	Tan, V., Daluiski, A., Simic, P. and Hotchkiss, R.N. (2006) Outcome of Open Release for Post-Traumatic Elbow Stiffness. Journal of Trauma, 61, 673-678. http://dx.doi.org/10.1097/01.ta.0000196000.96056.51
[18]	Lindenhovius, A.L., Linzel, D.S., Doornberg, J.N., Ring, D.C. and Jupiter, J.B. (2007) Comparison of Elbow Contracture Release in Elbows with and without Heterotopic Ossification Restricting Motion. Journal of Shoulder and Elbow Surgery, 16, 621-625. http://dx.doi.org/10.1016/j.jse.2007.01.005
[19]	Cikes, A., Jolles, B.M. and Farron, A. (2006) Open Elbow Arthrolysis for Posttraumatic Elbow Stiffness. Journal of Orthopaedic Trauma, 20, 405-409. http://dx.doi.org/10.1097/00005131-200607000-00007
[20]	Husband, J.B. and Hastings II, H. (1990) The Lateral Approach for Operative Release of Post-Traumatic Contracture of the Elbow. Journal of Bone and Joint Surgery. American Volume, 72, 1353-1358.
[21]	Ayadi, D., Etienne, P., Burny, F. and Schuind, F. (2011) Results of Open Arthrolysis for Elbow Stiffness. A Series of 22 Cases. Acta Orthopaedica Belgica, 77, 453-457.
[22]	Kim, S.J. and Shin, S.J. (2000) Arthroscopic Treatment for Limitation of Motion of the Elbow. Clinical Orthopaedics and Related Research, 375, 140-148. http://dx.doi.org/10.1097/00003086-200006000-00017
[23]	Nguyen, D., Proper, W., MacDermid, S.I.J.C., King, G.J.W. and Faber, K.J. (2006) Functional Outcomes of Arthroscopic Capsular Release of the Elbow. Arthroscopy, 22, 842-849. http://dx.doi.org/10.1016/j.arthro.2006.04.100
[24]	Nathan, L., Van Zeeland, N.L. and Yamaguchi, K. (2010) Arthroscopic Capsular Release of the Elbow. Journal of Shoulder and Elbow Surgery, 19, 13-19. http://dx.doi.org/10.1016/j.jse.2010.01.003
[25]	Pederzini, L., Tosi, M., Prandini, M. and Nicoletta, F. (2013) Elbow Arthroscopy in Stiff Elbow. In: Elbow Arthroscopy, Springer, Berlin, 43-56. http://dx.doi.org/10.1007/978-3-642-38103-4_5
[26]	Noojin, F., Savoie, F. and Field, L. (2001) Arthroscopic Release of the Stiff Elbow. Techniques in Shoulder & Elbow Surgery, 2, 17-25. http://dx.doi.org/10.1097/00132589-200103000-00003
[27]	Ball, C.M., Meunier, M., Galatz, L.M., Calfee, R. and Yamaguchi, K. (2002) Arthroscopic Treatment of Post-Traumatic Elbow Contracture. Journal of Shoulder and Elbow Surgery, 11, 624-629. http://dx.doi.org/10.1067/mse.2002.126770
[28]	Cefo, I. and Eygendaal, D. (2011) Arthroscopic Arthrolysis for Posttraumatic Elbow Stiffness. Journal of Shoulder and Elbow Surgery, 20, 434-439. http://dx.doi.org/10.1016/j.jse.2010.11.018
[29]	Cohen, A.P., Redden, J.F. and Stanley, D. (2000) Treatment of Osteoarthritis of the Elbow: A Comparison of Open and Arthroscopic Debridement. Arthroscopy, 16, 701-706. http://dx.doi.org/10.1053/jars.2000.8952
[30]	Kelly, E.W., Morrey, B.F. and O’Driscoll, S.W. (2001) Complications of Elbow Arthroscopy. Journal of Bone and Joint Surgery. American Volume, 83, 25-35.