Open arthrolysis versus arthroplasty in the treatment of posttraumatic elbow stiffness

Elbow stiffness is a common problem following trauma to the elbow. Sixty-seven patients with posttraumatic elbow stiffness were surgically treated between 1985 - 2000. Sixty-one were clinically reviewed after a mean follow-up of 15 years (range: 7 to 19 years). The initial trauma had resulted in 8 intrinsic, in 31 extrinsic and in 28 mixed lesions. The mean preoperative flexion – extension arc of motion, was 46°. After an unsuccessful conservative treatment, open surgical arthrolysis was performed in 59 patients with exclusively extrinsic or mixed lesions, through a lateral approach combined with a medial approach when deemed necessary. In patients with complex intrinsic lesions was performed 3 resection arthroplasty and 5 total elbow arthroplasty. At final follow-up, the mean arc of motion of the elbow was significantly improved to 100° in 56 patients who had undergone open arthrolysis; 3 were lost to follow-up. Among the 3 patients who had undergone arthroplasty resection, only one had a markedly improved elbow function with a 90° arc of motion; elbow stiffness had recurred in the other two patients. Of the 5 patients who underwent total elbow arthroplasty, 3 were lost to follow-up; the other 2 patients had a stable elbow, with a fair arc of motion of 60° and 70° respectively, both with a flexion contracture of 20°. Complications included 2 superficial infections, which healed following conservative treatment, and one fracture following remodeling of a malunited distal fracture of the humerus. In the treatment of the posttraumatic stiffness of the elbow, the arthrolysis and the arthroplasty are indicated in dependence on the existent (extrinsic or intrinsic) lesions and on their severity.