Open arthrolysis with pie-crusting release of the triceps tendon for treating post-traumatic contracture of the elbow

Background: Extensive loss of elbow flexion compromises the performance of daily activities. We examined the clinical outcomes of patients with post-traumatic extension contracture of the elbow treated with open arthrolysis and pie-crusting release of the triceps tendon. Methods: We retrospectively reviewed the records of 7 patients (5 men and 2 women; mean age, 35 years) who underwent open arthrolysis via a combined lateral and medial approach with pie-crusting release of the triceps tendon for the treatment of post-traumatic elbow stiffness. All the patients had heterotopic ossification that restricted elbow motion and underwent removal of the ossified tissue and capsular release. The triceps tendon was gradually stretched by making multiple stab incisions on the tendon by using a No. 11 surgical blade. The range of motion of the elbow was recorded both preoperatively and at the final postoperative follow-up. Elbow function was assessed with the Mayo Elbow Performance Score. Results: The patients were followed up for a mean of 24 months. After treatment, significant improvement was noted in the total arc of motion (from 44 degrees to 116 degrees, P<.001), mean flexion (from 80 degrees to 124 degrees, P<.001), and mean extension (from 31 degrees to 8 degrees, P=.004). The mean Mayo Elbow Performance Score improved significantly from 59 points preoperatively to 92 points at the final evaluation. No major postoperative complications developed in any of the patients. Conclusion: Our findings indicate that open arthrolysis with pie-crusting release of the triceps tendon is an effective and safe treatment approach for post-traumatic extension contracture of the elbow. Level of evidence: Level IV; Case Series; Treatment Study (C) 2016 Journal of Shoulder and Elbow Surgery Board of Trustees.