Nonsurgical treatments for post-traumatic elbow contractures: approaches for the prevention of their development and progression

Post-traumatic contractures are a frequent complication of elbow fractures or dislocations. Periarticular structures such as ligaments, muscle-tendon units, and the joint capsule undergo a fibrotic reaction in response to the injury. While operative approaches are commonly used to address post-traumatic contractures, the results of these procedures infrequently provide restoration of full range of motion (ROM). Nonsurgical methods offer the potential to prevent the development of post-traumatic contractures following injury, or to be an adjunct to an operation to restore full motion following operative release of established post-traumatic contractures. Using animal models of post-traumatic contractures, several authors have reported on nonsurgical methods to alter collagen, inhibit proliferation of (myo)fibroblasts, or modify hyaluronic acid, inflammation or growth factors. Three small, nonrandomized clinical trials have examined nonsurgical adjunct approaches to prevent contractures after fracture-dislocations or recurrence of contractures after operative releases of established contractures. A review of these articles is followed by a discussion of approaches and platforms to advance the understanding of the pathological processes, identify candidate agents, proof of principle in animal models, clinical trials for efficacy and safety, and adoption into