Stability of severely stiff elbows after complete open release: treatment by ligament repair with suture anchors and hinged external fixator

被引:28
作者
Wang, Wei [1 ]
Jiang, Shi-chao [1 ]
Liu, Shen [1 ]
Ruan, Hong-jiang [1 ]
Fan, Cun-yi [1 ]
机构
[1] Shanghai Jiao Tong Univ, Peoples Hosp 6, Dept Orthopaed, Shanghai 200233, Peoples R China
关键词
Elbow stiffness; severe; release; instability; ligament; anchor; hinged external fixator; MEDIAL COLLATERAL LIGAMENT; OPEN ARTHROLYSIS; SURGICAL-TREATMENT; RECONSTRUCTION; CONTRACTURE; INSTABILITY; MANAGEMENT; ARTHROPLASTY; BIOMECHANICS; REPLACEMENT;
D O I
10.1016/j.jse.2014.03.013
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Instability is a crucial issue in severe post-traumatic elbow stiffness during complete-release surgery. This study aimed to evaluate the efficacy of ligament repair using a suture anchor in the operative treatment of severely stiff elbows for which a hinged external fixator was indicated. Methods: We retrospectively reviewed 46 cases of severely stiff elbows (flexion arc <60 degrees) undergoing open release. During the operation, all 46 elbows were noted to have instability. Suture anchors were applied to restore the ligament if it was impossible to repair the ligament directly, and a hinged external fixator was simultaneously applied to protect the vulnerable ligament and facilitate rehabilitation. No allograft or autograft was used in any of our cases. The stability, arc of motion, Mayo Elbow Performance Score, ulnar nerve symptoms, and radiographs were evaluated. Results: At a mean follow-up of 24.3 months, the postoperative Mayo Elbow Performance Score was 91 points, as compared with 63 points preoperatively. The mean flexion arc improved from 25 degrees to 126 degrees. Three patients presented with moderate elbow instability when the hinged external fixator was removed; however, all of them regained stability by the last follow-up. Furthermore, 7 cases of new-onset nerve palsy were noted; however, all of them resolved with conservative management. None of the patients required secondary surgery for any reason. Conclusions: Repair of an avulsed collateral ligament with suture anchors and hinged external fixation was effective in restoring functional mobility in patients with severe post-traumatic elbow stiffness after complete release. This could be an option for treating ankylosed, severely or very severely stiff elbows. (C) 2014 Journal of Shoulder and Elbow Surgery Board of Trustees.
引用
收藏
页码:1537 / 1544
页数:8
相关论文
共 36 条
[1]   Anatomy and biomechanics of the elbow [J].
Bryce, Chris D. ;
Armstrong, April D. .
ORTHOPEDIC CLINICS OF NORTH AMERICA, 2008, 39 (02) :141-+
[2]   Posttraumatic Elbow Stiffness [J].
Charalambous, Charalambos P. ;
Morrey, Bernard F. .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2012, 94A (15) :1428-1437
[3]  
Ehsan A, 2011, J HAND SURG S8, V36, P50
[4]   Surgical management of posttraumatic elbow arthrofibrosis [J].
Ehsan, Amirhesam ;
Huang, Jerry I. ;
Lyons, Matt ;
Hanel, Douglas P. .
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, 2012, 72 (05) :1399-1403
[5]   Open debridement and radiocapitellar replacement in primary and post-traumatic arthritis of the elbow: a multicenter study [J].
Giannicola, Giuseppe ;
Angeloni, Renzo ;
Mantovani, Alberto ;
Rebuzzi, Enrico ;
Merolla, Giovanni ;
Greco, Alessandro ;
Sacchetti, Federico M. ;
Nofroni, Italo ;
Cinotti, Gianluca ;
Postacchini, Franco .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2012, 21 (04) :456-463
[6]   Valgus instability of the elbow due to medial epicondyle nonunion: Treatment by fragment excision and ligament repair - A report of 5 cases [J].
Gilchrist, AD ;
McKee, MD .
JOURNAL OF SHOULDER AND ELBOW SURGERY, 2002, 11 (05) :493-497
[7]   Medial Collateral Ligament Reconstruction [J].
Greiwe, R. Michael ;
Bjerke-Kroll, Benjamin ;
Ahmad, Christopher S. .
OPERATIVE TECHNIQUES IN ORTHOPAEDICS, 2009, 19 (04) :243-250
[8]   Biomechanics of a less invasive procedure for reconstruction of the ulnar collateral ligament of the elbow [J].
Hechtman, KS ;
Tjin-A-Tsoi, EW ;
Zvijac, JE ;
Uribe, JW ;
Latta, LL .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1998, 26 (05) :620-624
[9]   Outcomes of open arthrolysis of the elbow without post-operative passive stretching [J].
Higgs, Z. C. J. ;
Danks, B. A. ;
Sibinski, M. ;
Rymaszewski, L. A. .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2012, 94B (03) :348-352
[10]   Physical Examination of the Athlete's Elbow [J].
Hsu, Stephanie H. ;
Moen, Todd C. ;
Levine, William N. ;
Ahmad, Christopher S. .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2012, 40 (03) :699-708