Utilising an internal joint stabilizer to ensure post-release elbow stability for patients with severe post-traumatic elbow stiffness: A retrospective cohort study.

Abstract

Objective: The treatment of severe post-traumatic elbow stiffness is extremely complex. Complete open release of the elbow joint and reconstruction of stiffness-related injuries are considered crucial; however, these procedures may lead to elbow instability, particularly chronic instability due to underlying conditions. This retrospective study aimed to assess the outcomes of using an internal joint stabilizer (IJS) to ensure post-release stability in these complex cases.

Hypothesis: IJS would demonstrate reliability as a treatment technique for severe elbow stiffness associated with intraoperative instability.

Materials and methods: Overall, 15 patients (10 men and 5 women; mean age 42 years [range, 20-72 years]) treated for post-traumatic elbow stiffness between September 2016 and October 2020 developed instability following complete arthrolysis. The surgical procedures performed included ulnar nerve neurolysis followed by anterior transposition, comprehensive release of the surrounding soft tissue, heterotopic bone removal, bone reconstruction, concentric reduction of the elbow joint, and ligament repair. An IJS was used to maintain the stability of the elbow and protect the repaired soft tissue. The flexion arc, forearm rotation, Mayo Elbow Performance Score, and pain score were evaluated preoperatively and postoperatively. All patients were evaluated for ≥1 postoperative years.

Results: The median follow-up duration was 34 months. Significant improvements were observed in the median (range) extension-flexion arc (from 50 ° [15-60 °] to 120 ° [80-140 °], difference of medians 70 °; p < 0.05), forearm rotation (from 85 ° [20-115 °] to 165 ° [145-180 °], difference of medians 80 °; p < 0.05), Mayo Elbow Performance Score (from 55 ° to 90 °, difference of medians 35; p < 0.05), and the pain score (from 5 to 1, difference of medians 4; p < 0.05) at the final follow-up visit. The complication rate was 33.3 % (n = 5).

Conclusion: Despite the limited sample size, preliminary findings suggest that this technique may serve as a viable method to ensure elbow stability after arthrolysis for severe elbow stiffness, supporting postoperative rehabilitation and enhancing functional recovery.

Level of evidence: IV.