Surgical Management of the Posttraumatic Stiff Elbow: A Step-Wise Algorithm for Open Osteocapsular Release

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Rehabilitation Medicine

Background:

• Posttraumatic elbow stiffness is a common complication limiting functional activities.
• Limited motion often persists despite intensive therapy and rehabilitation, necessitating surgical intervention.
• Preoperative assessment includes patient history, physical examination (focusing on ulnar nerve status), and imaging (radiographs, CT).

Purpose of the Study:

• To present a step-wise algorithm for open osteocapsular release in posttraumatic elbow contractures.
• To outline the surgical approach and postoperative management for improving elbow range of motion.
• To highlight the importance of tailored surgical techniques and immediate rehabilitation.

Main Methods:

• Open osteocapsular release utilizing a step-wise algorithm.
• Initial anterior and posterior release via a lateral approach, with an optional medial approach.
• Intraoperative assessment of stability via stress testing under fluoroscopy; postoperative pain management with an indwelling nerve catheter.

Main Results:

• Open elbow contracture release demonstrates improvement in range of motion, patient health status, and disability scores.
• The presented algorithm guides surgical approach based on contracture pathology and surgeon preference.
• Immediate postoperative rehabilitation is crucial for achieving significant range of motion improvements.

Conclusions:

• Open osteocapsular release is an effective treatment for posttraumatic elbow stiffness.
• A structured surgical approach and immediate rehabilitation are vital for successful outcomes.
• Patients can expect significant improvement in elbow range of motion following adequate surgical release and postoperative care.