Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion

Joint stiffness is a common complication of elbow trauma. Treating elbow stiffness is challenging, especially in patients with severe elbow stiffness with distal humeral nonunion. To improve treatment outcomes, the authors applied a hinged external fixator after performing open reduction and internal fixation and evaluated the clinical outcome. Between 2005 and 2011, eleven patients with elbow stiffness and distal humeral nonunion underwent open arthrolysis, surgical reduction, internal fixation, hinged external fixation, and selective bone grafting. The ulnar nerve was anteriorly transposed in all patients. Elbow range of motion, Mayo Elbow Performance Score, and radiographs were assessed pre- and postoperatively. All patients achieved solid union in an average of 5.6 months. Preoperatively, mean flexion was 86.8°, mean extension was 45.5°, and mean total range of motion was 41.3°. Postoperatively, mean flexion was 125.9°, mean extension was 11.8°, and mean total range of motion was 114.1°. Mean Mayo Elbow Performance Score also significantly improved from 59 points preoperatively to 87.2 points postoperatively, and 6 patients were scored as excellent (more than 90 points), 3 good (75-90 points), and 2 fair (60-74 points) according to the Mayo Elbow Performance Score. A stiff elbow with distal humeral nonunion can be treated successfully using a unilateral hinged external fixator to supplement the open reduction and internal fixation. A hinged external fixator was an effective rehabilitation method for improving range of motion and maintaining joint stability.