Olecranon Osteotomy-Facilitated Elbow Release (OFER)

The olecranon osteotomy-facilitated elbow release (OFER) is a safe and effective method for releasing severe posttraumatic elbow contractures. The OFER procedure is easier, faster, and relatively less invasive, and appears to offer superior outcomes, compared with more traditional techniques.

An olecranon osteotomy provides a trapdoor through which the surgeon will have circumferential access to the joint and will be able to address all intrinsic and extrinsic causes of contracture. Access from the posterior to the anterior compartment is achieved by detaching the origin of the medial collateral ligament (MCL) and hinging the joint from medially to laterally, pivoting around the intact lateral collateral ligament. Once the olecranon and MCL are repaired, the elbow is stable enough for the patient to participate in intensive rehabilitation protocols.

The first line of treatment for elbow contracture is physical therapy, focusing on range of motion and using modalities such as static-progressive and dynamic splinting protocols. In some select cases, there is also a role for manipulation under anesthesia. When nonoperative methods fail, elbow contractures may be treated surgically, using either open or arthroscopic techniques. Authors have described open release involving medial, lateral, and anterior approaches. The first outcome report of a posterior approach to treat elbow contractures has recently been published¹.

An open approach usually utilizes 1 or possibly 2 large incisions and involves invasive dissection through muscle and nerve mobilization. This may result in a postoperative hematoma and usually substantial pain, posing a challenge for rehabilitation. Arthroscopic techniques are less invasive, with potentially fewer complications, but are far more technically challenging. Also, most extrinsic and some intrinsic causes cannot be adequately addressed through the arthroscope. The outcomes of OFER have been found to be superior to those reported after either arthroscopic or more conventional open procedures. In addition, we believe that the OFER procedure is substantially faster and technically easier than either other open or arthroscopic releases, although we are not aware of any studies addressing this topic.