Logo of The Journal of Bone & Joint Surgery (Br)
Quick search:        
          Advanced Search
Guest Access | Sign In
Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 5, 614-618.
doi: 10.1302/0301-620X.90B5.19999  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow My Folders
Right arrow Download to citation manager
Google Scholar
Right arrow Articles by Ruch, D. S.
Right arrow Articles by Papadonikolakis, A.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Ruch, D. S.
Right arrow Articles by Papadonikolakis, A.

Release of the medial collateral ligament to improve flexion in post-traumatic elbow stiffness

D. S. Ruch, MD, Professor, Director of the Hand Service1; J. Shen, MD, PhD, Resident2; G. D. Chloros, MD, Research Fellow2; E. Krings, RN, Nurse2; and A. Papadonikolakis, MD, PhD, Resident2

1 Department of Orthopaedic Surgery Duke University, DUMC 3466, Durham, North Carolina 27710, USA.
2 Department of Orthopaedic Surgery Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.

Correspondence should be sent to Professor D. S. Ruch; e-mail: d.ruch{at}duke.edu

Contracture of the collateral ligaments is considered to be an important factor in post-traumatic stiffness of the elbow. We reviewed the results of isolated release of the medial collateral ligament in a series of 14 patients with post-traumatic loss of elbow flexion treated between 1998 and 2002. There were nine women and five men with a mean age of 45 years (17 to 76). They were reviewed at a mean follow-up of 25 months (9 to 48). The operation was performed through a longitudinal posteromedial incision centred over the ulnar nerve. After decompression of the ulnar nerve, release of the medial collateral ligament was done sequentially starting with the posterior bundle and the transverse component of the ligament, with measurement of the arc of movement after each step. If full flexion was not achieved the posterior half of the anterior bundle of the medial collateral ligament was released.

At the latest follow-up, the mean flexion of the elbow improved significantly from 96° (85° to 115°) pre-operatively to 130° (110° to 150°) at final follow-up (p = 0.001). The mean extension improved significantly from 43° (5° to 90°) pre-operatively to 22° (5° to 40°) at final follow-up (p = 0.003). There was a significant improvement in the functional outcome. The mean Broberg and Morrey score increased from a mean of 54 points (29.5 to 85) pre-operatively to 87 points (57 to 99) at final follow-up (p < 0.001). All the patients had normal elbow stability.

Our results indicate that partial surgical release of the medial collateral ligament is associated with improved range of movement of the elbow in patients with post-traumatic stiffness, but was less effective in controlling pain.






(c) British Editorial Society of Bone and Joint Surgery All Rights Reserved
Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General