Summary
Forty two cases of stiff elbow were treated by operation. Thirty three were subsequent to trauma, seven were due to ectopic ossification after quadriplegia, and two were associated with massive ectopic ossification after long term coma following head injury. Two separate skin incisions, postero-medial or medial and anterior, were used in most cases. In the post-traumatic cases, scarred, thickened posterior oblique fibres of the medial collateral ligament were usually found. Ectopic ossification was frequently situated on the postero-medial aspect of the stiff elbows. Resection of the thickened fibres or the ectopic ossification was the most effective procedure to improve elbow flexion. The average improvement in range of motion was 59° in post-traumatic cases, 72° in ectopic ossification after quadriplegia and 127° in ectopic ossification following coma.
Résumé
Quarante-deux cas de raideur du coude ont été traités chirurgicalement. Parmi cux, 33 cas, etaient post-traumatiques, 7 cas étaient dûs à une ossification ectopique (OE) après quadriplégie et 2 cas étaient une OE importante après un coma prolongé dû à un traumatisme crânien. Deux incisions, l'une postéro-interne ou interne, l'autre antérieure ont été utilisées dans la plupart des cas. Dans les cas post-traumatiques, l'élément pathologique le plus caractéristique était la présence de fibres épaisses, obliques postérieures, au niveau du ligament latéral interne (LLI). Les ossifications ectopiques étaient localisées dans la plupart des cas dans la région postéro-interne du coude. La résection de ces LLI et/ou de l'ossification ectopique était le procédé le plus efficace pour améliorer la flexion du coude. L'amélioration moyenne de la mobilité a été de 58,8° dans les cas post-traumatiques, de 72,1° dans les cas d'OE après quadriplégie, et de 127,5° dans les cas d'OE due au coma.
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Itoh, Y., Saegusa, K., Ishiguro, T. et al. Operation for the stiff elbow. International Orthopaedics 13, 263–268 (1989). https://doi.org/10.1007/BF00268509
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DOI: https://doi.org/10.1007/BF00268509