Anterior release of the elbow for extension loss

Abstract

Background: There are many causes of elbow contracture. When nonoperative techniques fail to increase the arc of motion of the elbow, surgical intervention may be indicated. The purpose of this study was to report the outcomes of surgical correction, predominantly with an anterior release, of elbow flexion contractures. In addition, we evaluated the efficacy of continuous passive motion in the immediate postoperative period.

Methods: We retrospectively reviewed the outcomes of 106 consecutive patients who had undergone anterior elbow release for the treatment of a flexion contracture between July 1975 and June 2001. Twenty-nine patients were excluded because they had been followed for less than twelve months, leaving a study group of seventy-seven patients. Postoperatively, fifty-four of the seventy-seven patients were treated with continuous passive motion and the other twenty-three patients were treated with extension splinting. The average duration of follow-up was thirty-three months. The average patient age was thirty-four years. The results were evaluated on the basis of both preoperative and postoperative radiographs as well as clinical measurements of elbow motion, all performed by the same examiner using the same large (47-cm-long) goniometer.

Results: The mean preoperative extension in the seventy-seven patients was 52 degrees, which decreased to 20 degrees postoperatively. The mean flexion increased from 111 degrees preoperatively to 117 degrees postoperatively, and the mean total arc of motion increased from 59 degrees to 97 degrees. The total arc of motion in the patients treated with continuous passive motion increased 45 degrees, compared with an increase of 26 degrees in those treated with extension splinting. There were eleven complications in ten patients. The majority were traction neuropathies. There were two infections (one superficial and one deep), both of which resolved following treatment.

Conclusions: Release of a pathologically thickened anterior elbow capsule through a predominantly anterior approach to correct diminished elbow extension is a safe and effective technique. Furthermore, compared with splinting in extension alone, the utilization of continuous passive motion during the postoperative period increases the total arc of motion.