Hinged Elbow External Fixation for Severe Elbow Stiffness

J 2019

Hinged Elbow External Fixation for Severe Elbow Stiffness

FERANEC, Martin, Radek HART, Tomáš KOZÁK a Martin KOMZÁK

Základní údaje

Originální název

Hinged Elbow External Fixation for Severe Elbow Stiffness

Název česky

Užití zevní fixace loketního kloubu při uvolnění ztuhlosti loketního kloubu

Autoři

FERANEC, Martin (703 Slovensko, garant), Radek HART (203 Česká republika, domácí), Tomáš KOZÁK (203 Česká republika) a Martin KOMZÁK (203 Česká republika, domácí)

Vydání

Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca, Praha, Galén, 2019, 0001-5415

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30211 Orthopaedics

Stát vydavatele

Česká republika

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 0.256

Kód RIV

RIV/00216224:14110/19:00110216

Organizační jednotka

Lékařská fakulta

UT WoS

000466619700007

Klíčová slova anglicky

stiffed elbow; arthrolysis; external fixation

Štítky

14110711, podil, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 11. 5. 2020 09:47, Mgr. Tereza Miškechová

Anotace

V originále

PURPOSE OF THE STUDY The elbow is a highly constrained synovial hinge joint that frequently becomes stiff after injury. Grade 4 elbow stiffness (ankylosis) is a strongly limiting factor in the patient s daily activities and is difficult to treat. Hinged external fixation of the elbow provides the advantages of static fixation with the benefits of continued motion of the joint. The goal of our study was to assess the improvement in the range of motion of the elbow after surgical arthrolysis using a posterior extensile approach to the joint with or without using external fixation. MATERIAL AND METHODS Sixteen patients aged between 19 and 46 years with grade 4 elbow stiffness were operated on. The stiffness was caused by the following pathologies: 7 elbow dislocations, 3 radial head fractures, 4 distal humeral fractures, 2 fracture-dislocations. The average range of motion before surgery was 14 (range 0-20). The average interval between primary injury and arthrolysis was 24 months (9-60 months). The clinical assessment before and after the surgery was based on the Mayo Elbow Performance Score (MEPS). The average follow-up was 30 months (18-50 months). Arthrolysis was completed by application of an external fixator in eight patients. RESULTS A few common complications were observed, including the injury to adjacent neurovascular structures (two cases of temporary irritation of the ulnar nerve, one case of temporary irritation of the radial nerve) and three cases of pin-track infections. None of the patients showed elbow instability. In Group I, in which external fixation was used, the average MEP score increased from 51 points (range, 30 to 70) to 78 points (range, 55 to 90). The average range of motion at the final follow-up was 93 (range, 75-135). In Group II, in which no external fixation was used, the average MEP score increased from 53 points (range, 35 to 70) to 76 points (range, 55 to 85). The gain in flexion-extension was 88 (range, 65-135). The final improvement in the range of motion depended mostly on the severity of preoperative stiffness and subsequent surgery. DISCUSSION The surgical arthrolysis of the ankylosed elbow is not a procedure commonly performed by majority of hospitals. A precise surgical technique is a prerequisite for success of the procedure. The type of injury did not seem to influence the final result. Articular external fixation potentially provides stability while permitting the movement. CONCLUSIONS Open arthrolysis of a severe elbow contracture results in a substantial gain in motion (with or without using elbow external fixation) and gives reliable long-lasting results. The minimal improvement in motion provided by the hinge fixator does not justify the associated increase in the risk of complications.

Citovat

FERANEC, Martin, Radek HART, Tomáš KOZÁK a Martin KOMZÁK. Hinged Elbow External Fixation for Severe Elbow Stiffness. Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca. Praha: Galén, 2019, roč. 86, č. 2, s. 136-140. ISSN 0001-5415.

@article{1546295,
   author = {Feranec, Martin and Hart, Radek and Kozák, Tomáš and Komzák, Martin},
   article_location = {Praha},
   article_number = {2},
   keywords = {stiffed elbow; arthrolysis; external fixation},
   language = {eng},
   issn = {0001-5415},
   journal = {Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca},
   title = {Hinged Elbow External Fixation for Severe Elbow Stiffness},
   url = {https://www.ncbi.nlm.nih.gov/pubmed/31070573},
   volume = {86},
   year = {2019}
}

TY  - JOUR
ID  - 1546295
AU  - Feranec, Martin - Hart, Radek - Kozák, Tomáš - Komzák, Martin
PY  - 2019
TI  - Hinged Elbow External Fixation for Severe Elbow Stiffness
JF  - Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca
VL  - 86
IS  - 2
SP  - 136-140
EP  - 136-140
PB  - Galén
SN  - 00015415
KW  - stiffed elbow
KW  - arthrolysis
KW  - external fixation
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31070573
L2  - https://www.ncbi.nlm.nih.gov/pubmed/31070573
N2  - PURPOSE OF THE STUDY The elbow is a highly constrained synovial hinge joint that frequently becomes stiff after injury. Grade 4 elbow stiffness (ankylosis) is a strongly limiting factor in the patient s daily activities and is difficult to treat. Hinged external fixation of the elbow provides the advantages of static fixation with the benefits of continued motion of the joint. The goal of our study was to assess the improvement in the range of motion of the elbow after surgical arthrolysis using a posterior extensile approach to the joint with or without using external fixation. MATERIAL AND METHODS Sixteen patients aged between 19 and 46 years with grade 4 elbow stiffness were operated on. The stiffness was caused by the following pathologies: 7 elbow dislocations, 3 radial head fractures, 4 distal humeral fractures, 2 fracture-dislocations. The average range of motion before surgery was 14 (range 0-20). The average interval between primary injury and arthrolysis was 24 months (9-60 months). The clinical assessment before and after the surgery was based on the Mayo Elbow Performance Score (MEPS). The average follow-up was 30 months (18-50 months). Arthrolysis was completed by application of an external fixator in eight patients. RESULTS A few common complications were observed, including the injury to adjacent neurovascular structures (two cases of temporary irritation of the ulnar nerve, one case of temporary irritation of the radial nerve) and three cases of pin-track infections. None of the patients showed elbow instability. In Group I, in which external fixation was used, the average MEP score increased from 51 points (range, 30 to 70) to 78 points (range, 55 to 90). The average range of motion at the final follow-up was 93 (range, 75-135). In Group II, in which no external fixation was used, the average MEP score increased from 53 points (range, 35 to 70) to 76 points (range, 55 to 85). The gain in flexion-extension was 88 (range, 65-135). The final improvement in the range of motion depended mostly on the severity of preoperative stiffness and subsequent surgery. DISCUSSION The surgical arthrolysis of the ankylosed elbow is not a procedure commonly performed by majority of hospitals. A precise surgical technique is a prerequisite for success of the procedure. The type of injury did not seem to influence the final result. Articular external fixation potentially provides stability while permitting the movement. CONCLUSIONS Open arthrolysis of a severe elbow contracture results in a substantial gain in motion (with or without using elbow external fixation) and gives reliable long-lasting results. The minimal improvement in motion provided by the hinge fixator does not justify the associated increase in the risk of complications.
ER  -

FERANEC, Martin, Radek HART, Tomáš KOZÁK a Martin KOMZÁK. Hinged Elbow External Fixation for Severe Elbow Stiffness. \textit{Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca}. Praha: Galén, 2019, roč.~86, č.~2, s.~136-140. ISSN~0001-5415.

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