Reformative Application Of Hinged External Fixation For Elbow Stiffness

PurposeElbow stiffness is a common complication of elbow trauma.Open elbow arthrolysis is a prevalent treatment for elbow stiffness.Open release often lead to elbow instability,while ligament repair combined with hinged external fixation helps to maintain elbow stability and promote rehabilitation.However,complications of hinged external fixation seriously impact the clinical outcome.This study aimed at presenting a reformative way to apply hinged external fixation in elbow arthrolysis,proving the efficacy and safety of this new surgical procedure,and providing a theoretical basis and treatment strategy for clinical diagnosis and treatment of elbow stiffness.MethodA prospective,self-controlled study was performed.Patients who were diagnosed as posttraumatic elbow stiffness and received open elbow arthrolysis in our hospital were reformatively applied hinged external fixation.The external fixator was fixed in middle humerus and distal radius.In order to assess the effectiveness of the technology,elbow motion,Mayo elbow performance score,patient satisfaction rate as well as complications were documented before operation and at postoperative 2 weeks,6 weeks,3 months and 6 months.In order to evaluate the safety of this technology,two-points discrimination of first web,muscle strength of pollicis and wrist,first web distance,wrist motion,forearm rotation arc were recorded before operation and at postoperative 1 day,3 days,1 week,2 weeks,6weeks,3 months and 6 months.ResultsFor the duration of 6-month follow-up,elbow motion arc and elbow performance score significantly increased(P<0.05).Two-points discrimination of first web was not different form preoperative value(P>0.05)during follow-ups.From postoperative 1day to 6 weeks,first web distance and muscle strength of pollicis and wrist temporarily decreased(P<0.05),while it recovered at 6-week follow-up(P>0.05).Wrist extension arc had a significant decrease(P<0.05)during the first three months postoperatively,while it restored at 3-month follow-up(P>0.05).Wrist flexion arc as well as ulnar and radial deviation showed a transient deficit during first two weeks postoperatively(P<0.05),patient regained arc of motion at 2-week follow-up(P>0.05).No serious complication occurred except for pin site erythema in 9 patients.No case need a secondary operation.ConclusionOpen elbow release combined with reformative application of hinged external fixation was effective for elbow stiffness.This technology reduced complication rate of external fixator.The reformative application was safe in treating stiff elbow,while it had a transient influence on pollicis motion,wrist motion and forearm rotation during the first 6 months postoperatively.