Arch Hand Microsurg.  2022 Jun;27(2):140-148. 10.12790/ahm.22.0001.

A combined anterior and posterior approach for elbow ankylosis

• Kim YS
• Kim J
• Kang KS
• Bae KJ
• Baek GH

• KMID: 2531920
• DOI: http://doi.org/10.12790/ahm.22.0001

Abstract

Purpose
An ankylosed elbow should be released with consideration of the nature of the stiffness and location of the pathologic structures, and care should be taken to avoid damage to the surrounding musculature and neurovascular structures. We report the clinical results of a combined anterior and posterior approach, which allowed safe access with good visibility, for severe elbow stiffness.
Methods
We retrospectively reviewed patients who underwent surgical release for elbow ankylosis from August 2014 to May 2020. All operations were performed by the same surgeon at a single institution. The final outcomes were assessed by measuring the range of motion, calculating the Mayo Elbow Performance Score (MEPS), and reading radiologic images.
Results
Eight patients with a mean age of 43 years (range, 21–65 years) were included in the study, and the mean follow-up period was 22 months. The average range of motion was 13° of flexion contracture (range, 0°–40°) and 123° of further flexion (range, 100°–140°) at the last follow-up. The average net improvement in the total arc compared to patients’ preoperative status was 68° (range, –10°–130°). The mean postoperative MEPS was 89 points (range, 70–100 points). The development of heterotopic ossification and recalcitrant rheumatoid arthritis caused relatively poor outcomes.
Conclusion
The combined anterior and posterior approach allows safe access with good visibility for elbow ankylosis, while minimizing the risk of neurovascular injury and preserving the medial and lateral muscles.

Keyword

Ankylosis; Heterotopic ossification; Elbow joint; Contracture release; Surgical approach

Figure

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  Fig. 1. A 51-year-old man with heterotopic ossification that occurred after a burn (patient 5). (A) Massive heterotopic ossification was observed in the olecranon fossa and posteromedial aspect of the elbow on preoperative X-rays. (B) The posterior incision was designed on the lateral side, avoiding an extensive burn scar at the medial aspect of the elbow. (C) The ulnar nerve (asterisk) was released, and the posteromedial aspect of the capsule was excised. (D) After removal of the large heterotopic ossification, the olecranon fossa (arrow) was exposed.

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  Fig. 2. A 25-year-old man with juvenile rheumatoid arthritis (patient 6) underwent extensive synovectomy through a combined anterior and posterior approach. (A) The thickened joint capsule was exposed via an anterior approach. (B) After synovectomy, the coronoid fossa (arrow) was exposed. (C, D) The triceps was detached from the posterior aspect of the humerus. Synovectomy was performed on the lateral side (B) and medial side (C), and the olecranon fossa (asterisk) was exposed (D).

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  Fig. 3. A 21-year-old woman with 60° flexion contracture (patient 8) underwent contracture release by an anterior approach. (A) The thickened lacertus fibrosus (arrow) was incised and anterior capsulectomy was performed. (B) During the process, the median nerve (asterisk) was identified and protected. (C) A full range of motion was achieved postoperatively.

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  Fig. 4. A 35-year-old woman with heterotopic ossification in her left elbow that occurred after surgical treatment for fractures of the distal humerus and the olecranon (patient 2). (A, B) Heterotopic ossification of the olecranon fossa and coronoid fossa was sufficiently removed. (C) Postoperatively, a range of motion close to normal was obtained.

Reference

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