A Comparative Study Of Hinged External Fixation And Plaster Fixation After Surgical Release In The Treatment Of Stiff Elbow

Objective:To analysis the results of follow-up and clinical data in patients of stiff elbows treated with hinged external fixation and plaster fixation after surgical release and compare the two kinds of treatment, then evaluate the value of ulnar nerve decompression in patients with ulnar nerve compression.Methods:Retrospectively analyzed the clinical data of15stiff elbow patients treated with hinged external fixation and plaster fixation after surgical release, all of which are collected form January2011to December2012in Trauma Department of Shandong Provincial Orthopedics Hospital. There were11males and4females, their ages ringing from24to49years with an average of35.2years old. The causes of injury include elbow dislocation with radial head fracture in8patients, olecroanon fracture in4patients and supracondylar fracture of the humerus in3patients. Time of injury to surgical release ranging from0.75to2years with an average of1.2years. Range of movement in the injured elbow, according to Morrey classification:5are very severe stiff (range.of movement≤30°),10are severe stiff (range of movement30°-60°).3patients are pronation limited, wih an average range of movement of27.1°,4patients are supination limited, wih an average range of movement of20.3°.6patients have ulnar nerve compression symptoms, with5males and1females. Mayo score of elbow function before surgery:0is excellent,1is good,3is fair and1is poor. All the patients are treated with surgical release and ulnar nerve neurolysis, then8patients were fixed with hinged external fixation and7with plaster fixation. Functional exercises begins the day after the surgery and persist for4-6months. Take advantage of Mayo score of elbow function to evaluate the elbow function and measure the range of elbow movement after surgery, using Amadio scores to evaluate the ulnar nerve function in patients with ulnar nerve compression symptoms before and after surgery. Using SPSS17.0statistical software process the data of preoperative and postoperative Mayo scores, Amadio scores and the range of movements of the elbow. Using the paired t test to compare metering data. P<0.05difference is statistically significant.Results:The mean operative time was120min (range from90to160min), the average blood loss was430mL (range from200to600mL). No one was lost to the follow-up. In hinged external fixation group2patients suffered from pin tract infections and they are treated with alcoholic tampon covering. In plaster fixation group1patient suffered from superficial skin infection, which cure well with changing fresh dressing for wound and using antibiotics.All the patients’elbows are completely released, without fixation failure. Patients with ulnar nerve compression symptoms all have different degrees of improvement after surgery. The average Amadio score before surgery In hinged external fixation group is4.50and the average Amadio score after surgery is7.83, the difference is statistically significant(P<0.05). The average Amadio score before surgery In plaster fixation group is4.67and the average Amadio score after surgery is8.00, the difference is statistically significant(P<0.05). Both before and after surgery the difference between the two groups is not statistically significant(P>0.05).The mean range of movement of patients before surgery in hinged external fixation group is98.75°in flexion,61.25°in extension, the range of movement(ROM) is37.5°,and the mean range of movement after surgery is122.50in flexion,32.50°in extension, the range of movement(ROM) is90.00preoperative and postoperative differences in paired comparison is statistically significant (P<0.05). The mean range of movement of patients before surgery in plaster fixation group is100.00°in flexion,61.43°in extension, the range of movement(ROM) is38.57°,and the mean range of movement after surgery is115.71in flexion,34.29°in extension, the range of movement(ROM) is81.43°, preoperative and postoperative differences in paired comparison is statistically significant (P＜0.05). Before surgery the difference in flexion, extension and the ROM between the2groups is not statistically significant(P>0.05). And after surgery the difference in flexion and ROM between the2groups is statistically significant(P<0.05), the difference in extension between the2. groups is not statistically significant(P>0.05). preoperative and postoperative differences in paired comparison is statistically significant (P＜0.05).The MEPS after surgery:3is excellent,10is good,1is fair and1is poor, the excellent and good rate was86.7%, in the hinged external fixation group,3is excellent,4is good,1is fair and0is poor, the excellent and good rate was87.5%, in the plaster group,0is excellent,6is good,0is fair and1is poor, the excellent and good rate was87.5%. The Amadio scores in patients with ulnar nerve compression symptoms is4.50in average before surgery and7.83in average after surgery. Preoperative and postoperative differences in paired comparison is statistically significant (P＜0.05)Conclusion:Hinged external fixation and plaster fixation after surgical release are both effective in the treatment of stiff elbow, and the ulnar nerve neurolysis can significantly improve the symptoms associated with compression. In compare with plaster fixation, the hinged external fixation after surgical release can well ensure the scope of activities of elbow joint after operation, have good maintenance of elbow joint stability and is convenient for observing the condition of soft tissue around the elbow joint. However, the hinged external fixation is very expensive and have some complications, such as pin tract infections. So we should choose the appropriate treatment according to actual situation.