Hand and Upper Extremity Unit, Hospital Fremap,Majadahonda, Madrid, Spain

Purpose: To assess the functional and occupational outcome of open elbow arthrolysis for post-traumatic extrinsic contractures.

Material and Methods: Prospective evaluation of 60 consecutive cases (86% male, 14%female) of post-traumatic extrinsic elbow stiffness. Average age was 37 years (24-48). Moderate to high physical demand at work in 96% of cases. 56% of cases involved the right side. Open arthrolysis (column procedure) trough a lateral (72%) or posterior (28%) approach followed a minimum rehabilitation period of 6 months post original injury. In 8 cases, an anterior transposition of the ulnar nerve was required. Patients received postoperative analgesia with Bupivacaine 0,0125% trough an indwelling catheter. No chemical or radiotherapy ectopic calcification prophylaxis was used. Postoperative complications, range of motion, Xray evaluation, time to return to work, activity level and workers´ compensation were evaluated at the end of follow up (24 months, range 12-36).

Results: Complications occurred in 14% of cases. Two patients required revision surgery for ectopic calcifications restricting prono-supination. The flexo-extension (FE) arc of motion improved from 49 º to 115 º and that of prono-supination (PS) from 100 º to 158 º The results were found to be statistically significant for FE (p = 0.054) and PS (p>0,00001). In 20% of cases, patients returned to their previous job with some restrictions (33% disability) and 12% changed to a less physically demanding occupation.

Conclusion: Open arthrolysis is an effective surgical procedure to improve mobility in post-traumatic stiff elbows. It is indicated when the joint interline is preserved. Good functional and occupational outcome in a high percentage of case in the working population was observed.