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[Distraction arthrodiatasis in elbow stiffness]
Dietmar Pennig1, Konrad Mader, Steffen Heck
1St. Vinzenz-Hospital Köln, Akademisches, Lehrkrankenhaus der Universität zu Köln, Köln, Germany. dietmar.pennig@vinzenz-hospital.de
Objective:
Loss of motion of the elbow is not uncommon after trauma, burns, or coma and severely impairs upper limb function. Loss of motion may be difficult to avoid and is challenging to treat. Detailed analysis of the etiology and diagnostic evaluation are of utmost importance for planning any surgical intervention for elbow stiffness. Most activities of daily living are possible, if the elbow has a range of motion of 100 degrees (30-130 degrees of flexion, Morrey's arc of motion).
Indications:
Stiff elbow, usually defined as less than 30 degrees extension or less than 130 degrees flexion.
Contraindications:
Poor compliance, poorly controlled diabetes mellitus, active hepatitis B and C infection, HIV infection, acute articular infection.
Surgical Technique:
Current operative techniques, such as closed distraction with external fixation (arthrodiatasis), are presented and evaluated. Elbow arthrolysis is a technically demanding procedure.
Postoperative Management:
If indication and techniques are used correctly and surgeon, physiotherapist, and patient are familiar with the procedure, good long-term results may be achieved.
Results:
In 14 children and adolescents the results after 5 years showed an increase of preoperative range of motion from 37 degrees to 108 degrees (flexion/extension; 75-130 degrees ) postoperatively.
