[Retrospective study of 23 arthrolyses of the elbow for post-traumatic stiffness: result predicting factors]

The goal of the study was to determine the results of elbow arthrolysis for post-traumatic stiffness, and to identify factors governing the result of that procedure.

Between 1984 and 1997, 26 elbow arthrolysis were performed. Twenty-three patients were retrospectively assessed by an independent examiner, 3 patients were lost for follow-up. The mean age at surgery was 41 years. The traumatisms responsible for stiffness were: 5 elbow dislocations, 7 radial head fractures, 3 olecranon fractures, 8 humeral palette fractures. The surgical approach was 2 times posterior, 9 times lateral, 12 times combined (posterior and lateral). The surgical approach was chosen according to the preoperative analysis of the stiffness factors and the scars in case of previous surgery.

At follow-up (85 months (12-144)), 5 patients were very satisfied, 17 patients were satisfied and one patient was not satisfied. Six patients had discomfort in daily gesture. Ten patients had no pain, 6 had pain while effort and 7 had climatic pain. Two ulnar palsies existing at arthrolysis did not improve after neurolysis and anterior ulnar nerve transposition. Range of motion increased in every sector of mobility, and at follow-up mean ROM was: 121 degrees flexion, -31 degrees extension, 69 degrees pronation and 65 degrees supination. The average absolute benefit in flexion-extension was about 38 degrees. The average relative (flexion-extension) benefit according to Merle d'Aubigné was about 44%. At follow-up, the average pronation-supination was higher than 100 degrees. The range of motion was not correlated to the type of injury, to the surgical management, nor to the type of rehabilitation program. Likewise, the delay between traumatism and arthrolysis had no influence on the result. On the other hand, the range of motion was directly correlated to the preoperative mobility and mobility obtained just after surgery (p = 0.001). However, the range of motion at follow-up was slightly decreased (5 degrees to 15 degrees) compared to the mobility obtained just after surgery.

The final range of motion was mainly related to the severity of the preoperative stiffness. We noticed that few patients were bothered in daily gestures, in spite of a relative stiffness. The type of injury did not seem to influence the final result. Elbow arthrolysis remains a mobilizing technique giving reliable long-lasting results.

The range of motion obtained after arthrolysis performed because of elbow post-traumatic contracture is mainly related to preoperative stiffness. By comparing with postoperative range of motion, a loss of 5 degrees to 10 degrees can be predicted.