Review articleThe Posttraumatic Stiff Elbow: A Review of the Literature
Section snippets
Etiology
Loss of motion of the elbow is commonplace after elbow trauma.1, 5, 6, 7, 8 The etiology of posttraumatic stiffness can be multifactorial and can include arthrosis,9, 10 heterotopic bone,11, 12, 13 or failure of fracture healing14, 15, 16 along with contracture of the soft tissues around the elbow.7 Why the elbow is so prone to contracture has been open to debate and deserves further investigation. Regan and Reilly17 postulated 3 potential factors: (1) the complex articular congruity and
Assessment
A functional arc needed to perform most basic daily activities is defined as an arc of flexion from 30° to 130° and an arc of forearm rotation from 50° of pronation to 50° of supination.105 However, the functional impairment depends on the individual requirements of each patient.106
It is important to understand the original injury and initial treatment as well as other associated conditions such as neurologic dysfunction, infection, and ipsilateral limb injury.106, 107 In most cases,
Nonsurgical Treatment
If posttraumatic stiffness develops in spite of precautionary measures such as early active motion, it has the potential for succesful nonsurgical treatment. Regaining joint motion in the most time-efficient manner is critical for return to function, control of rehabilitation costs, and to prevent the need for additional surgery.
The use of turnbuckle-like splints to restore motion of the posttraumatic stiff elbow was described in the Medieval era by the German surgeon Hans von Gersdorff
Surgical Treatment
If nonsurgical treatment fails to restore a functional arc of motion, surgical treatment may be considered.8, 19, 106, 125, 126 Traditionally, surgery has been offered to patients with flexion contractures or extension contractures of at least 30°. However, the justification of surgical intervention is highly individualized, and the patient’s needs and the ability of the surgeon to realize these expectations should be considered, with a mutual assessment of risks and benefits of the
Postoperative Management and Rehabilitation
Although the rehabilitation program for each of the surgical procedures has its unique features, the postoperative management should be aimed at (1) restoring a functional arc of motion, (2) regaining muscle power, and (3) reincorporating the limb into functional activities.177
Most authors start mobilization of the elbow within 2 days after an open contracture release,8, 51, 52, 64, 65, 125, 126, 128, 133, 134, 137, 202 which may be enhanced by sufficient pain control.8, 125, 127, 132, 202, 203
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Cited by (110)
Management of Post-traumatic Elbow Stiffness
2023, Operative Techniques in OrthopaedicsA modified-delphi study establishing consensus in the therapeutic management of posttrauamtic elbow stiffness
2022, Journal of Hand TherapyThe post-traumatic stiff elbow: A review
2021, Journal of Clinical Orthopaedics and TraumaComparison of arthroscopy-assisted vs. open reduction and fixation of coronoid fractures of the ulna
2021, Journal of Shoulder and Elbow SurgeryMobilizing orthoses in the management of post-traumatic elbow contractures: A survey of Australian hand therapy practice
2021, Journal of Hand TherapyCitation Excerpt :Most of the evidence on stretching, joint mobilizations, and heat in post-traumatic elbow contractures is based on expert opinions or in healthy populations.19-22 A consensus among clinicians is that therapy should never be too aggressive and the use of strong passive stretching should be discouraged.23 Placing excessive loads on tissues beyond their normal elastic range can cause tissue microtears and ruptures.24
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Supported by Annafonds, Leiden, The Netherlands; Stichting Prof. Michael van Vloten Fonds, Rotterdam, The Netherlands; Stichting Wetenschappelijk Onderzoek Orthopaedische Chirugie, Bussum, The Netherlands. Dr. Jupiter is supported by Wyeth Co., Madison, NJ; Amgen Co., Thousand Oaks, CA; and Small Bone Innovations, New York, NY.