Distraction Arthrolysis of Posttraumatic Elbow Stiffness With a Hinged External Fixator

Abstract

The treatment of elbow stiffness remains a challenge for orthopedic surgeons. A hinged external fixator with distraction ability has recently emerged as a new option in the surgical treatment of elbow stiffness. Between January 2007 and December 2009, twenty-five posttraumatic stiff elbows (mean patient age, 29.2 years) received distraction arthrolysis from 1 surgeon group (W.J.W., L.H., P.Z.J.) at the authors' institution. For patients with only periarticular soft tissue contracture (grade 1), close mechanical distraction was performed with the assistance of an external fixator under anesthesia; open arthrolysis was avoided as much as possible. For patients who also had heterotopic ossification (grade 2), it was removed through a limited approach before the external fixator was applied. For patients with osteoarticular surface damage or destruction (grade 3), osteoarticular integrity was restored before arthrolysis. Range of motion increased markedly, from 33.4° (range, 0°-75°) preoperatively to 105.6° (range, 80°-140°) immediately postoperatively (Student's t test, P<.05). Of the 25 patients, 23 were followed for a mean of 16 months. No serious complications occurred. Mean range of motion was 97.4° (range, 70°-130°) at final follow-up, a significant increase from preoperatively (Student's t test, P<.05). No significant loss of range of motion was found at final follow-up compared with intraoperative values (average 8.2° loss; Student's t test, P>.05). This study suggests that a hinged external distraction fixator is a less invasive option for treating posttraumatic elbow stiffness and prevents contracture recurrence after arthrolysis.