Surgical treatment of extraarticular elbow contracture

The problem of the contracted elbow is well-recognized for the circumstances under which it develops and the difficulty of operative and non-operative treatment. Earlier studies report this problem in an unfavorable manner; however, current studies suggest that posttraumatic stiffness of the elbow, particularly when the articular surface is left intact, may be treated reliably. The authors present a specific surgical approach to the elbow that has posttraumatic motion limitation described as extrinsic, that is, primarily attributable to contracture of the capsule and periarticular soft tissues. The limited surgical exposure termed the column procedure allows anterior capsular exposure through an interval in the brachioradialis and extensor carpi radialis longus. Using this procedure the authors report the treatment of 38 elbows (38 patients) with sufficient followup to accurately describe the postoperative course. At a mean of 3.5 years after surgery the total postoperative arc of motion improved from approximately 50 degrees to approximately 90 degrees. There were minimal complications. A static adjustable splint rather than physical therapy is used postoperatively. It is concluded that newer surgical techniques with carefully described programs can be successful in the majority of patients undergoing surgical release for extrinsic contracture of the elbow.