Comparative study of the functional outcomes of combined medial-lateral approach arthrolysis with or without external fixation for severe elbow stiffness

Background To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods We retrospectively collected and analyzed the clinical data of patients with severe elbow stiffness who were treated in our institution from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results The average follow-up time was 28.4 ± 3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and treatment cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of evidence Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

3 Months Old Post-Traumatic Stiff Elbow Following Terrible Triad Injury - A Case Report and Review of Literature

Stiff elbow is a common problem associated with terrible triad injuries which if not managed properly can lead to significant functional limitations. Here we are describing a case of post-traumatic stiff elbow following terrible triad who presented to us after taking native treatment primarily. He was treated with open arthrolysis and prophylactic ulnar nerve decompression along with rigorous physiotherapy including dynamic splinting with hinge elbow bracing. The results were satisfactory in achieving a functional range of movement according to the patient's vocational need. This study aims to present the prompt management of post-traumatic stiff elbow case along with functional improvement postoperatively in a decisive way. Terrible triad injuries are a group of the rare and severely unstable fracturedislocations following which the chance of recurrent instability, elbow stiffness, and functional limitations increases coherently.1 To perform normal daily activities, painless motion at the elbow joint is very much necessary and critical. Following a traumatic insult, a cascade of events can lead to a decrease in the normal arc of motion and also cause stiffness of the elbow joint.2 Over the last two decades, there has been a lot of speculation revolving around the management of terrible triad injuries.3 Van Riet et al had documented that the majority of the terrible triad injuries need to be managed surgically whereas the non-operative treatment is reserved for a few selected cases. 4 The ones which were not managed adequately had higher chances of turning up into stiff elbow. Post-traumatic elbow stiffness is one of the dreaded complications following terrible triad injuries.3 The aim of managing the case of post-traumatic stiff elbow is to have a painless, near-normal range of motion which can help the patient to do daily activities by himself. We are presenting a case of post-traumatic type- 4 stiff elbow following native bandage treatment and how prompt management has led to satisfactory results.

Comparative Study of the Functional Outcomes of Combined Medial-lateral Approach Arthrolysis With or Without External Fixation for Severe Elbow Stiffness

Background: To evaluate and compare the functional outcomes of combined medial-lateral approach open arthrolysis with and without hinged external fixation. Methods: We retrospectively collected and analysed the clinical data of patients with severe elbow stiffness who were treated in our center from January 2018 to January 2019. All of them were treated with combined medial-lateral approach arthrolysis. There were 20 patients who had the hinged external fixation placed and 29 patients without the placement of the external fixation. Their baseline characteristics and functional outcomes were evaluated and compared. Results: The average follow-up time was 28.4±3.7 months. There were no significant differences in the ROM of the elbow, MEPS, VAS, DASH, or complications between the two groups. The operation time and cost of the patients without external fixation were significantly lower than patients with external fixation. Conclusion: Combined medial-lateral approach open elbow arthrolysis without external fixation is a safe and effective way to treat elbow stiffness. Level of Evidence: Therapeutic Level III; Retrospective Cohort Comparison; Treatment Study.

Wrist Arthrolysis: A Systematic Review of Open and Arthroscopic Techniques

Background Wrist arthrolysis is a viable option in wrist stiffness and can be performed via open or arthroscopic techniques. Purpose The aim of the study is to describe and evaluate the available techniques of open and arthroscopic arthrolysis of the radiocarpal joint and the distal radio ulnar joint (DRUJ) in posttraumatic wrist stiffness. Methods A systematic literature search was performed in PubMed to identify studies reporting on open and arthroscopic wrist arthrolysis. Key words included “open wrist arthrolysis,” “arthroscopic wrist arthrolysis,” “post-traumatic wrist stiffness,” and “DRUJ arthrolysis.” Data were extracted independently by a pair of reviewers. Results Overall, 637 studies were identified; 13 additional articles were found through previous publications (total 650 articles). A total of 612 records resulted after duplicates was removed. Fourteen studies were selected and only eight respected the inclusions criteria. One study focused on volar open arthrolysis and four studies on arthroscopic arthrolysis of the radiocarpal joint; two studies reported on open arthrolysis and two studies on arthroscopic DRUJ arthrolysis. Range of motion following open and arthroscopic wrist arthrolysis improved in all studies. Conclusion Both arthroscopic and open arthrolysis can lead to similar and satisfactory results in radiocarpal joint and DRUJ stiffness.. Level of Evidence This is a level 3a study.

SURGICAL TREATMENT OF THE KNEE JOINT CONTRACTURES AFTER TOTAL KNEE ARTHOPLASTY

Background: The development of contractures after total knee replacement is most often associated with arthrofibrosis and makes up 1.3% - 5.7% of the total number of cases of joint replacement. Conservative treatment is ineffective. Arthrolysis is pathogenetically substantiated (arthroscopic or open). Aims: assessment of the effectiveness of arthrolysis as a method of treating knee joint contractures after arthroplasty, comparison of the results of arthroscopic and open arthrolysis, analysis of complications. Materials and methods: Compare two groups. In group 1, 57 patients underwent arthroscopic arthrolysis. In group 2, 54 patients underwent open arthrolysis. The operations were performed from 2015 to 2019, the observation period ranged from one year to three years. As criteria for the result of treatment, KSS data were used (general and functional assessment of the knee joint), as well as separately the amplitude of movements in the joint before surgery and at different times after it. Results: One of the results of this work was the optimization of arthroscopic arthrolysis technique. Improved surgical access and joint revision sequence. According to the KSS scale and range of motion, the best results were obtained in group 1. Especially important is the lesser number of complications in comparison with the 2nd group requiring repeated interventions, including revision arthroplasty. In the 1st group of such cases there were 3 (5.3%), in the 2nd group - 7 (13.0%). Conclusions: Arthroscopic arthrolysis is a less traumatic and more effective treatment for arthritis of the knee. It seems appropriate to gradually displace open arthrolysis by arthroscopic.

A prospective comparison of short-term results after arthroscopic and open elbow procedures in elbow stiffness

Background Surgical treatment of the stiff elbow can be performed either arthroscopically or via an open approach. There is a paucity of direct prospective comparisons of the techniques in the literature. Objectives The aim of the study is to analyze the clinical short-term results of arthroscopic and open elbow arthrolysis in postoperative and posttraumatic stiff elbows. Materials and methods The study group consisted of 44 patients divided in two cohorts, one after arthroscopic arthrolysis (33 patients) and the other including patients after open arthrolysis (11 patients). Range of motion (ROM; extension/flexion), pain (numerical rating scale, NRS), as well as the disabilities of the arm, shoulder, and hand (DASH) score were recorded preoperatively and examined in a standardized manner 6 weeks, 3 months, and 6 months after surgery. Results In both groups, preoperative elbow movement significantly improved in the follow-up. An increase from 103.3° (±23.4) to 123.5° (±12.5°; p = 0.001) was seen after 6 months for the arthroscopic group, whereas the mean ROM significantly increased from 64.5° (±31.1°) to 100.9° (±25.6°; p = 0.007) following open arthrolysis. In the arthroscopic group, the DASH score was measured at 37.3 points (±23.4 points) and improved to 16.1 points (±16.5 points) after 6 months, while in the open group it enhanced after 6 months (19.5 points [±17.5 points]) compared to its preoperative value by 38.2 points (±24.1 points). A consistent improvement was found for NRS, which decreased after surgery in both groups (arthroscopic group = −3.1 [±3.0]; open group = −2.0 [±2.9]). Complications did not occur in either group. When comparing delta values of the groups between the preoperative ROM, DASH score, and NRS, no significant differences were observed (p < 0.05). Conclusions Good to excellent functional recovery was seen in both cohorts when evaluating for improvement in the DASH score, the gain in elbow motion, and the decrease in pain. No significant differences were found between the procedures regarding pre- and postoperative measurements. The arthroscopic approach has developed to become an effective alternative to treat posttraumatic elbow stiffness.