Grading of functional results of elbow joint arthrolysis after fracture treatment

Abstract

In the treatment of posttraumatic contracture of the elbow joint, arthrolysis is a proven procedure. We used a stepwise operative approach starting laterally and including an additional medial and dorsal incision if needed. A total of 91 patients with arthrolysis of the elbow could be followed-up on average 44 months (range 9–102 months) joint after operative (58, 63.7%) and non-operative (33, 36.3%) fracture treatment. The mean preoperative range of motion (ROM) in flexion/extension was 49° (SD ± 38°), while in pronation/supination it was 89° (SD ± 66°). Postoperatively, the ROM was on average 94° (SD ± 27°) in flexion/extension and 129° (SD ± 52°) in pronation/supination. Using our own grading system, it became evident that most patients had a functional benefit from the procedure, although the quality of the improvement differed. For example, postoperatively 59.3% of the patients were grade I (≥ 90°) in flexion/extension compared with 16.5% preoperatively. Although the rest also showed improvements, their functional benefit was less. The earlier the release of the joints was performed, the better was the functional outcome (p < 0.05). The importance of an intensive early rehabilitation programme is emphasised while indications for this procedure should only be seen in compliant patients.