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. 2019:59:180-184.
doi: 10.1016/j.ijscr.2019.04.036. Epub 2019 May 16.

Functional elbow range of motion 6 months after contracture release and ORIF K-wire in elbow stiffness with malunion capitellum and neglected radial head and ulnar dislocation: a case report

Wahyu Widodo  1 , M Ade Refdian  2 , Ajiantoro  2
Affiliations

Functional elbow range of motion 6 months after contracture release and ORIF K-wire in elbow stiffness with malunion capitellum and neglected radial head and ulnar dislocation: a case report

Wahyu Widodo et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Elbow stiffness is the most common complication following trauma of the elbow. This is because the elbow joint is susceptible to effusion, hemarthrosis, scarring, and capsule thickening due to its small intracapsular volume. Surgical treatment is therefore necessary to release soft tissue contracture.

Case: A male teenager was unable to flex his elbow since 1 year prior to admission after falling down during football practice. He didn't seek any medical treatment and had his elbow massaged since 5 months ago. On physical examination, his right elbow was extended, with flexion-extension range of motion (ROM) of 300 - 00. On the radiograph, there was malunion fracture of left capitellum and neglected posterosuperior dislocation of radial head and ulna. Surgery was performed to release contracture and correct the malunion. Normal activity with functional elbow flexion-extension ROM of 1100 - 300 was achieved in 6 months after operation.

Discussion: Elbow stiffness is a challenging case for surgeon, especially in regards of developing good perioperative plan. The aim of treatment for elbow stiffness is to achieve a pain-free and functional elbow ROM.

Conclusion: To achieve functional elbow ROM, surgical treatment was necessary to release the contracture. In addition, the etiology of trauma must be thoroughly investigated and a good rehabilitation program must be integrative to the treatment.

Keywords: contracture release; elbow stiffness; functional elbow range of motion; malunion capitellum fracture; neglected dislocation of radial head and ulnar.

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Figures

Fig. 1
Fig. 1
Elbow flexion-extension is limited to 300–00, pronation-supination is normal.
Fig. 2
Fig. 2
X-ray of the left elbow AP and lateral.
Fig. 3
Fig. 3
2D and 3D CT Scan reconstruction of the left elbow.
Fig. 4
Fig. 4
Ulnar nerve and heterotopic ossification identification (A), contracture release and ulnar nerve preservation (B), open reduction and internal fixation using K-Wire (C), final exposed and ulnar nerve transposition (D), immobilization using backslab in 900 flexion position (E), post-operative X-Ray (F).
Fig. 5
Fig. 5
Elbow's ROM comparison preoperative (flexion-extension 300–00) and 6 months postoperative (flexion-extension 1100–300).
See this image and copyright information in PMC

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