Debridement Arthroplasty for Post-Traumatic Stiff Elbow

후외상성 주관절 강직에서의 변연 관절 성형술

Stiffness of the elbow joint is relatively common after trauma, ectopic ossification, bum, postoperative scar, and etc. Mild flexion deformity can be reduced by use of active or passive motion exercise, dynamic sling, hinged distractor device, or turnbuckle orthosis. But these methods have disadvantages of difficulty in gaining acceptable range of motion only with stretching exercise, re-contracture after conservative managements and poor results that flexion contracture remained. The common described operative exposures for treatment of the stiff elbow are anterior, lateral, posterior, and medial approach. Through Anterior, lateral and medial approach each has not access to all compartments of the elbow. But, posterior approach has benefits that access to posterior, medial and lateral aspects of the elbow and as needed, fenestration to the olecranon fossa that produces a communication between the anterior and posterior compartments of the elbow are possible. From June 1991 through April 1997, 11 patients who had posttraumatic stiff elbow, were treated with debridement arthroplasty through the posterior approach. The purpose of this study are to introduce technique of the debridement arthroplasty and to evaluate final outcomes. With regarding to preoperative pain degree, mild degree matches to 3 cases, moderate to 3 cases, and severe to 2 cases. In preoperative motion, flexion was average 85° and extension was 30°. Postoperatively nine patients had got the complete relief of pain and two patients continued to have mild pain intermittentely. Postoperative flexion improved to 127° and extension to 2°, so that elbow flexion had improved by an average of 42° and elbow extension by 28°. On the objective scale all patients had good or excellent results and they all felt that they were improved by operation. Debridement arthroplasty is one of excellent procedures for the intractable stiff elbow if it is not unstable or it has not incongrous. But it need a meticulous operative technique and a well-programmed rehabilitation.