Results of open arthrolysis for elbow stiffness. A series of 22 cases.

Severe posttraumatic elbow stiffness represents a significant invalidity. Between 1990 and 2005 two surgeons performed open elbow arthrolysis in 30 adult patients (6 women, 24 men, mean age 30.8 years). All cases resulted from severe initial trauma, which had occurred on average 15.5 months previously. Four patients had extrinsic and 18 had mixed contractures; 13 had heterotopic ossifications. Operative complications included two peroperative joint instabilities and 3 transient nerve palsies. Seven elbows were remobilized under anaesthesia, one month after the arthrolysis. Twenty-two patients could be reviewed, on average 56 months after the arthrolysis. Seventy seven percent of the patients were satisfied. At final follow-up, the average arc of flexion-extension was 95 degrees +/- 15 degrees (average flexion 120 degrees +/- 13 degrees, average flexion contracture 31 degrees +/- 6 degrees), with a mean improvement of 51 degrees relative to the preoperative range (p < 0.001). The average arc of forearm rotation at final follow-up was 151 degrees +/- 23 degrees, with a mean improvement of 41 degrees (p < 0.05). No patient suffered persistent weakness or instability. The average VAS was 5/10, the average MEPI score 76, with 6 excellent, 6 good, 6 fair and 4 poor results, mainly because of persisting pain. The average DASH score was 31.6 and the average SF-36 was 66. Significant correlations were observed between VAS and DASH, MEPI and SF-36. This series demonstrates that open arthrolysis may restore acceptable elbow motion in young active patients presenting with elbow stiffness following major trauma. However, full restoration of motion is rare; only 18% of the patients regained the functional arcs of motion reported by Morrey, but the majority were satisfied, given their preoperative degree of elbow stiffness. The ultimate result from both the patient's and the surgeon's perspectives is strongly dependent on persisting pain, which was frequent in this series and influenced the DASH, MEPI and the SF-36 scores. Arthrolysis did not address the issue, if pain was the chief complaint.