Surgical Approach to the Posttraumatic Stiff Elbow

摘要

Posttraumatic elbow stiffness results from articular and extraarticular sources about the ulnohumeral, radiocapi-tellar, and proximal radioulnar joints. The underlying pathoanatomy is often complex, making a "simple" stiff elbow a relatively uncommon entity. Elbow release, or arthrolysis, removes the offending structures while maintaining elbow stability and the integrity of the crossing neurovascular structures. The procedure may be accomplished through deep medial or lateral muscular intervals depending on the anatomy and the location of any concomitant problems such as ulnar nerve dysfunction, heterotopic ossification, distal humerus nonunion, and posttraumatic arthritis, which need to be addressed. Results are generally favorable but do vary depending upon the initial injury, preoperative motion, presence of heterotopic ossification, and etiologic factors such as brain injury. Even attempts to surgically mobilize the completely ankylosed elbow are frequently worthwhile.