The Stiff Elbow Revisited: How Much Motion Can Surgery Really Restore?

Background and Objectives: Post-traumatic elbow stiffness is a disabling condition often resulting from a combination of capsular contracture, osseous impingement, and residual instability, rendering it exceptionally challenging to treat. The aim of this study was to evaluate the outcomes of a comprehensive surgical approach for the treatment of post-traumatic elbow stiffness. Materials and Methods: A retrospective case series of 20 consecutive patients treated between 2018 and 2025 was conducted. Etiologies included distal humeral fractures (n = 9), terrible triad injuries (n = 4), elbow dislocations (n = 3), olecranon fractures (n = 2), and neglected radial head fractures (n = 2). All patients underwent anterior and posterior arthrolysis with triceps tenolysis. Additional procedures included ligament reconstruction, radial head arthroplasty, anterior capsule repair, tricepsplasty, and ulnar nerve transposition when indicated. Elbow range of motion was assessed preoperatively and during follow-up at 2 weeks, 6 weeks, 3 months, 6 months, and 1 year postoperatively. Results: Mean flexion improved from 81.0° to 125.3°, while the extension deficit improved from 66.5° to 16.5°. Mean supination increased from 54.8° to 82.8°, and mean pronation from 67.0° to 84.5°. The mean flexion-extension arc improved from 14.5° to 108.8°, representing a mean gain of 94.3°. One transient sensory ulnar neuropathy and one case of postoperative triceps insufficiency requiring revision surgery were observed; one patient developed postoperative skin blistering following a posterior approach. Conclusions: Comprehensive, pathology-oriented surgical treatment resulted in substantial improvement in elbow motion and restoration of a functional range of movement.