Dual mediolateral mini-open technique for the release of elbow contracture

Traditional surgical options for releasing stiff elbows include open and arthroscopic techniques. The former involves long incisions and significant surgical trauma, while the latter is technique-demanding and carries a higher risk of nerve complications. This study was designed to (1) introduce a novel dual mediolateral mini-open releasing technique for elbow stiffness, (2) analyze the clinical outcomes of our proposed technique, and (3) investigate its advantages and limitations for surgical release of elbow contracture.

Patients who underwent dual medial and lateral mini-open surgeries for elbow stiffness performed by our surgical team between January 2017 and May 2022, with a minimum follow-up of 24 months, were recruited. We recorded the maximum flexion and extension angles, range of motion (ROM), Mayo Elbow Performance scores, visual analogue scale (VAS) scores, presence of heterotopic ossification, and ulnar neuropathy at each visit. Differences at pre-operative, post-operative, and last follow-up were analyzed. The lengths of surgical incisions and complications were also recorded.

A total of 21 patients (11 males and 10 females) with an average age of 36.47 ± 9.81 years at surgery were enrolled. The average follow-up period was 29.76 ± 7.31 months. Lateral and medial incisions averaged 4.1 ± 0.3 cm and 3.0 ± 0.2 cm, respectively. Preoperatively, the maximum extension, flexion angle, and ROM were 37.14 ± 13.24°, 99.05 ± 19.25°, and 61.90 ± 21.07°, respectively. By the latest follow-up, extension and flexion angles were 6.81 ± 6.78° and 138.33 ± 6.78°, and the ROM was 131.52 ± 10.77°. Significant improvement was also observed in Mayo Elbow Performance and VAS scores. Preoperatively, 13 patients exhibited sensory or motor deficits secondary to ulnar nerve entrapment. At discharge, 5 patients demonstrated persistent neuropathy, with one new-onset case. By final follow-up, 3 cases with pre-existing entrapment maintained residual symptoms. No revision surgeries were needed in our cohort by the latest follow-up.

The dual mediolateral mini-open technique allows for a safe and effective release of stiff elbows through small incisions of 3-5 cm in length. With comparable improvements to those reported in traditional surgical approaches, this technique could serve as a reliable alternative to arthroscopic release procedures, aiming for smaller incisions and reduced surgical trauma. However, it is not indicated for patients with severe elbow joint deformities.