Internal Brace Augmentation Following Ulnar Collateral Ligament Release for Elbow Stiffness: A Case Series

Background: Elbow stiffness is a common post-traumatic complication that may require surgical intervention in severe cases. Capsular and ulnar collateral ligament (UCL) release can restore motion but may result in iatrogenic valgus instability. Internal brace (IB) augmentation has emerged as a potential method to restore stability while preserving mobility. This study compares the utilization of IB augmentation following UCL release to conventional techniques. Methods: We report two cases of patients with severe post-traumatic elbow contractures and associated heterotopic ossification (HO). Both underwent HO excision, capsular release, and UCL release or excision followed by IB augmentation. Outcomes were assessed using range of motion (ROM), visual analog scale (VAS) pain scores, and radiographic evaluation at follow-up. Results: In Case 1, bilateral elbows improved from near ankylosis preoperatively to final arcs of motion from -15° extension to 120° flexion (left) and -15° to 125° (right), with VAS improving to 0. In Case 2, motion improved from -45° extension to 90° flexion preoperatively to -45° to 108° at final follow-up, with a VAS of 0. No valgus instability, subluxation, or HO recurrence was observed in either case. Conclusions: IB augmentation following UCL release is feasible and may provide effective stabilization while enabling meaningful improvements in elbow motion. Larger studies are needed to further evaluate its clinical utility and durability.