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Upper Limb: S. Sharma and L. A. Rymaszewski Open arthrolysis for post-traumatic stiffness of the elbow: RESULTS ARE DURABLE OVER THE MEDIUM TERM J Bone Joint Surg Br 2007; 89-B: 778-781 [Abstract] [Full text] [PDF]

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Open arthrolysis for post-traumatic stiffness of the elbow

Gino M. Kerkhoffs, René K. Marti   (23 August 2007)

Open arthrolysis for post-traumatic stiffness of the elbow 23 August 2007
Gino M. Kerkhoffs, Consultant Orthopedic and Trauma Surgery MD, PhD, René K. Marti Send letter to journal: Re: Open arthrolysis for post-traumatic stiffness of the elbow gino.kerkhoffs{at}kssg.ch Gino M. Kerkhoffs, et al.	Sir, We read this paper with great interest. A stiff elbow is usually defined as an elbow having a reduction of more than 30° in extension, or flexion less than 130°. Most activities of daily living are possible if the elbow has a range of motion of 100°, from 30° to 130° of flexion.1 Loss of movement is common after trauma to the elbow. An open arthrolysis has been a well-accepted operative solution to the problem of a disabling post-traumatic stiff elbow. Sharma and Rymaszewski have successfully treated 25 patients with a post-traumatic stiff elbow, with various approaches, and are to be complimented on the clear presentation of their work. However, we would like to make two remarks. First, the authors state in their discussion that the problem of a post-traumatic stiff elbow can only occasionally be solved by conservative treatment. However, they fail to cite the paper by Doornberg et al2 in which 29 consecutive patients were described with elbow stiffness after trauma and were treated with static progressive elbow splinting when a standard exercise program was no longer achieving gains in movement. Patients who were splinted after the initial injury regained greater movement during splinting than patients treated after elbow capsulectomy. Operative treatment of stiffness was avoided in most patients. We feel this paper should have been discussed and would like the authors to comment. Secondly, we feel that the authors should also have cited our paper 'Progressive surgical realease of a posttraumatic stiff elbow – technique and outcome after 2 to 18 years in 46 patients'.3 We described the results of 47 open arthrolyses after a mean follow-up of 10 years and reported good results. Also, continuous passive motion was reported to have a positive effect; no correlation was found between the functional results and the mechanism of injury, the operative release (lateral or lateral and medial), nor the age of the patients. Once more we would be grateful for the authors' comments. Did the authors find any correlation between injury mechanism, time between trauma and arthrolysis, the operative approach used, age of the patients and the final functional results? G.M. Kerkhoffs MD, PhD, Consultant Orthopedic and Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands, Department of Orthopedic and Trauma Surgery, Kantonsspital, Sankt Gallen, Switzerland. R.K. Marti MD, PhD, Consultant Orthopedic and Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands, Department of Orthopedic and Trauma Surgery, Klinik Gut, Sankt Moritz, Switzerland. 1. Morrey BF, Askew LJ, Chao EY. A biomechanical study of normal functional elbow motion. J Bone Joint Surg [Am] 1981;63-A:872-7. 2. Doornberg JN, Ring D, Jupiter JB. Static progressive splinting for posttraumatic elbow stiffness. J Orthop Trauma 2006;20:400-4. 3. Marti RK, Kerkhoffs GM, Maas M, Blankevoort L. Progressive surgical relase of a posttraumatic stiff elbow. Technique and outcome after 2-18 years in 46 patients. Acta Orthop Scand 2002;73:144-50.