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Aktuelle Traumatol 2004; 34(6): 282-288
DOI: 10.1055/s-2004-830321
Schwerpunktthema

Georg Thieme Verlag KG Stuttgart · New York

Posttraumatische Ellenbogengelenksteife - offene Arthrolyse über dorsale Inzision („global approach“)

Posttraumatic Elbow Contracture - Release Using a Posterior Incision (“Global Approach”)K. J. Faber1 , S. D. Patterson1 , L. P. Müller2 , G. J. W. King1
  • 1The Hand and Upper Limb Centre, St. Joseph's Health Centre, The University of Western Ontario, London, Ontario, Canada
  • 2Klinik und Poliklinik für Unfallchirurgie, Johannes-Gutenberg-Universität Mainz
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Publication History

Publication Date:
17 December 2004 (online)

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Zusammenfassung

27 Patienten nach offener Ellenbogengelenkarthrolyse wurden im Mittel 21 Monate postoperativ (Minimum 12 Monate, Maximum 33 Monate) klinisch nachuntersucht. In allen Fällen erfolgte die Operation über eine dorsale Längsinzision mit Darstellung und primärer Schonung der Seitenbänder. Anteriore und posteriore Kapselektomien wurden bei 26 Patienten durchgeführt. Ein dynamischer gelenküberbrückender Bewegungsfixateur wurde bei 4 Patienten bei Instabilität verwendet. Das mittlere präoperative Flexionsausmaß von 109° wurde auf durchschnittlich 136° verbessert. Der Gesamtbewegungsumfang Flexion/Extension lag präoperativ bei 59° und wurde auf 112° verbessert, die Unterarmrotation lag präoperativ bei 118° und postoperativ bei 159°. Die Verbesserungen der Bewegungsausmaße waren statistisch signifikant (t < 0,005). Der präoperative Mayo Elbow Performance Score (MEPS) wurde von 60 auf 85 zum Zeitpunkt der Nachuntersuchung verbessert (p < 0,05). Alle Patienten hatten eine verbesserte Ellenbogengelenkbeweglichkeit und verminderte Schmerzen entsprechend des MEPS. An postoperativen Komplikationen traten heterotope Ossifikationen, milde symptomatische postero-laterale rotatorische Instabilität bei einem Patienten und ein Pin-Infekt auf. Keinerlei Komplikationen traten im Zusammenhang mit der dorsalen Hautinzision auf. Die dorsale Hautinzision erlaubt eine globale Darstellung der betroffenen Strukturen bei posttraumatischer Ellenbogengelenksteife. Die Arthrolyse über diesen Zugang ist erfolgversprechend und sicher. Die Armfunktion und Ellenbogengelenkbeweglichkeit können gut verbessert werden und eine Schmerzreduktion tritt ein. Die Patientenzufriedenheit dieses Eingriffes ist sehr hoch.

Abstract

Twenty-seven patients who underwent an elbow contracture release were independently reviewed a mean of 21 (range 12 - 33) months following surgery. In all cases, a single posterior longitudinal incision was utilized to expose and preserve collateral ligament insertions. Anterior and posterior capsulectomies were performed in 26 patients. An articulated external fixator was applied to four patients when instability was recognized intraoperatively. Mean preoperative flexion of 109° was improved to 136°. The mean preoperative flexion-extension arc of 59° was improved to 112° and forearm rotation arc of 118° was improved to 159° following surgery. All improvements in range of motion were statistically significant (p < 0.005). Preoperative Mayo elbow performance score (MEPS) was 60 and at follow-up was 85 (p < 0.05). All patients had improved elbow motion and function and diminished pain as reflected in the MEPS. Postoperative complications included recurrent formation of heterotopic bone in one patient, mild asymptomatic posterolateral rotatory instability in one patient, and a pin tract infection in one patient. There were no complications associated with the skin incision. The posterior skin incision safely allows global exposure of the elbow for contracture release. Elbow contracture release is worthwhile and safe when performed using a posterior incision. Arm function and elbow motion was improved and pain was diminished. Patient satisfaction with the procedure was high.

Literatur

  • 1 Morrey B F. Post-traumatic contracture of the elbow.  J Bone Joint Surg. 1990;  72 601-618
    PubMedGoogle Scholar
  • 2 Urbaniak J R, Hansen P E, Beissinger S F, Aitken M S. Correction of post-traumatic flexion contracture of the elbow by anterior capsulectomy.  J Bone Joint Surg. 1995;  67 1160-1164
    PubMedGoogle Scholar
  • 3 Morrey B F, Askew R PT, An K N, Chao E Y. A biomechanical study of normal functional elbow motion.  J Bone Joint Surg. 1981;  72 601-618
    PubMedGoogle Scholar
  • 4 Bonutti P M, Windau J E, Ables B A, Miller B G. Static progressive stretch to reestablish elbow range of motion.  Clin Orthop. 1994;  303 128-134
    PubMedGoogle Scholar
  • 5 Duke J B, Tessler R H, Dell P C. Manipulation of the stiff elbow with patient under anesthesia.  J Hand Surg. 1991;  16 19-23
    CrossrefPubMedGoogle Scholar
  • 6 Glynn J J, Niebauer J J. Flexion and extension contracture of the elbow: surgical management.  Clin Orthop. 1976;  117 289-291
    PubMedGoogle Scholar
  • 7 Green D P, McCoy H. Turnbuckle orthotic correction of elbow-flexion contractures after acute injuries.  J Bone Joint Surg. 1979;  61 1092-1095
    PubMedGoogle Scholar
  • 8 Gelinas J J, Faber K J, Patterson S D, King G JW. Effectiveness of Turnbuckle splinting for elbow contractures.  J Bone Joint Surg. 2000;  82 74-78
    PubMedGoogle Scholar
  • 9 Zander C L, Healy N L. Elbow flexion contractures treated with serial casts and conservative therapy.  J Hand Surg. 1992;  17 694-697
    CrossrefPubMedGoogle Scholar
  • 10 Boerboom A L, de Mayeier H E, Verburg A D, Verhaar J AN. Arthrolysis for post-traumatic stiffness of the elbow.  International Orthopaedics. 1993;  17 346-349
    PubMedGoogle Scholar
  • 11 Gates III H S, Sullivan F L, Urbaniak J R. Anterior capsulectomy and continuous passive motion in the treatment of post-traumatic flexion contracture of the elbow: a prospective study.  J Bone Joint Surg. 1992;  74 1229-1234
    PubMedGoogle Scholar
  • 12 Cohen M S, Hastings 2nd H. Post-traumatic contracture of the elbow. Operative release using a lateral collateral ligament sparing approach.  J Bone Joint Surg. 1998;  80 805-812
    PubMedGoogle Scholar
  • 13 Hastings H, Graham T J. The classification and treatment of heterotopic ossification about the elbow and forearm.  Hand Clinics. 1994;  10 417-437
    PubMedGoogle Scholar
  • 14 Hertzel R, Pisan M D, Ballmer F. Operative management of the stiff elbow: Sequential arthrolysis based on a transhumeral approach.  J Shoulder Elbow Surg. 1997;  6 81-88
    CrossrefPubMedGoogle Scholar
  • 15 Husband J B, Hastings H. The lateral approach for operative release of post-traumatic contracture of the elbow.  J Bone Joint Surg. 1990;  72 1353-1358
    PubMedGoogle Scholar
  • 16 Jones G S, Savoie F H. Arthroscopic capsular release of flexion contractures (arthrofibrosis) of the elbow.  Arthroscopy. 1993;  9 277-283
    PubMedGoogle Scholar
  • 17 Karachalios T, Maxwell-Armstrong C, Atkins R M. Treatment of post-traumatic fixed flexion deformity of the elbow using an intermittent compression garment.  Injury. 1994;  25 313-315
    CrossrefPubMedGoogle Scholar
  • 18 Lamine A, Fikry T, Essadky B, Zryouil B. L'artholyse du coude - a propos de 70 cas.  Acta Orthop Belgica. 1993;  59 352-356
    PubMedGoogle Scholar
  • 19 Wada T, Ishii S, Usui M, Miyano S. The medial approach for operative release of post-traumatic contracture of the elbow.  J Bone Joint Surg. 2000;  82 68-73
    PubMedGoogle Scholar
  • 20 Kraushaar B S, Nirschl R P, Cox W. A modified lateral approach for release of posttraumatic elbow flexion contracture.  J Shoulder Elbow Surg. 1999;  8 476-484
    CrossrefPubMedGoogle Scholar
  • 21 Mansat P, Morrey B F. The column procedure: a limited lateral approach for extrinsic contracture of the elbow.  J Bone Joint Surg. 1998;  80 1603-1615
    PubMedGoogle Scholar
  • 22 Viola R W, Hanel D P. Early “simple” release of posttraumatic elbow contracture associated with heterotopic ossification.  J Hand Surg. 1999;  24 370-380
    CrossrefPubMedGoogle Scholar
  • 23 Phillips B B, Strasburger S. Arthroscopic treatment of arthrofibrosis of the elbow joint.  Arthroscopy. 1998;  14 38-44
    PubMedGoogle Scholar
  • 24 Nowicki K D, Shall L M. Arthroscopic release of a posttraumatic flexion contracture of the elbow: a case report and review of the literature.  Arthroscopy. 1992;  8 544-547
    PubMedGoogle Scholar
  • 25 Roberts J B, Pankratz D G. The surgical treatment of heterotopic ossification following long term coma.  J Bone Joint Surg. 1979;  61 760-763
    PubMedGoogle Scholar
  • 26 Seth M K, Khurana J K. Bony ankylosis of the elbow after burns.  J Bone Joint Surg. 1985;  67 747-749
    PubMedGoogle Scholar
  • 27 Shahriaree H, Sajadi K, Silver C M, Sheikholeslamzadeh S. Excisional arthroplasty of the elbow.  J Bone Joint Surg. 1979;  61 922-927
    PubMedGoogle Scholar
  • 28 Thompson H C, Garcia A. Myositis ossificans: Aftermath of elbow injuries.  Clin Orthop. 1967;  50 129-134
    PubMedGoogle Scholar
  • 29 Timmerman L A, Andrews J A. Arthroscopic treatment of posttraumatic elbow pain and stiffness.  Am J Sports Med. 1994;  22 230-235
    PubMedGoogle Scholar
  • 30 Weizenbluth M, Eichenblat M, Lipskeir E, Kessler I. Arthrolysis of the elbow: 13 cases of posttraumatic stiffness.  Acta Orthop Scand. 1989;  60 642-645
    PubMedGoogle Scholar
  • 31 Wilson P D. Capsulectomy for the relief of flexion contractures of the elbow following fracture.  J Bone Joint Surg. 1944;  26 71-86
    PubMedGoogle Scholar
  • 32 Dowdy P A, Bain G I, Patterson S DP, King G JW. The midline posterior elbow incision: an anatomic appraisal.  J Bone Joint Surg. 1995;  77 696-699
    PubMedGoogle Scholar
  • 33 Kocher T. Textbook of Operative Surgery. 3rd Ed. (Stiles HJ, Paul CB [transls]). London; A & C Black 1911
    Google Scholar
  • 34 Kaplan E B. Surgical approaches to the proximal end of the radius and its use in fractures of the head and the neck of the radius.  J Bone Joint Surg. 1941;  23 86
    PubMedGoogle Scholar
  • 35 Hotchkiss R N. Compass Universal Hinge: Surgical Technique. Smith and Nephew 1998: 8-12
    Google Scholar
  • 36 Morrey B F. The Elbow and its Disorders. 2nd Ed. Philadelphia; W. B. Saunders 1993
    Google Scholar
  • 37 Morrey B F, An K N. Functional anatomy of the ligaments of the elbow.  Clin Orthop. 1985;  210 84-90
    PubMedGoogle Scholar

Priv.-Doz. Dr. med. Lars P. Müller

Klinik und Poliklinik für Unfallchirurgie
Johannes-Gutenberg-Universität

Langenbeckstraße 1

55131 Mainz

Phone: 06131/17-2845

Fax: 06131/17-6687

Email: mueller@unfall.klinik.uni-mainz.de