RESEARCH PROGRESS OF COMPLICATIONS ASSOCIATED WITH OPEN ELBOW ARTHROLYSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAIJiangyu , WANGWei ,  FANCunyi

Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, 200233, P. R. China;

Corresponding author：

FANCunyi, Email: fancunyi888@hotmail.com

Keywords：

Elbow stiffness; Open elbow arthrolysis; Complication

DOI：

10.7507/1002-1892.20150023

Video：

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Objective To review the research progress of complications associated with open elbow arthrolysis so as to provide clinical reference for complication prevention and treatment. Methods The recent publications on open elbow arthrolysis and complications associated with it were extensively reviewed and analyzed. Results Complications associated with open elbow arthrolysis include ulnar nerve symptom and neuropathy, elbow instability, heterotopic ossification, and hematoma. Although some progress has been made in the complication prevention and treatment recently, there are still some challenges in the control of surgical trauma, intervention of heterotopic ossification and elbow instability after surgery, as well as postoperative analgesia due to the limitation of surgical techniques and the uncertain mechanism of these complications. Conclusion Open elbow arthrolysis is safe and effective for elbow stiffness. However, more research on the mechanism of complications should be carried out, to further improve the overall effect of the surgery.

Citation： CAIJiangyu, WANGWei, FANCunyi. RESEARCH PROGRESS OF COMPLICATIONS ASSOCIATED WITH OPEN ELBOW ARTHROLYSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(1): 113-117. doi: 10.7507/1002-1892.20150023 Copy

1.	Keschner MT, Paksima N. The stiff elbow. Bull NYU Hosp Jt Dis, 2007, 65(1):24-28.
2.	Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg (Am), 1990, 72(4):601-618.
3.	Higgs ZC, Danks BA, Sibinski M, et al. Outcomes of open arthrolysis of the elbow without post-operative passive stretching. J Bone Joint Surg (Br), 2012, 94(3):348-352.
4.	Morrey BF. Surgical treatment of extraarticular elbow contracture. Clin Orthop Relat Res, 2000, (370):57-64.
5.	Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg, 1973, 51(1):79-81.
6.	Nakano K, Murata K, Omokawa S, et al. Dynamic analysis of the ulnar nerve in the cubital tunnel using ultrasonography. J Shoulder Elbow Surg, 2014, 23(7):933-937.
7.	Gelberman RH, Yamaguchi K, Hollstien SB, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg (Am), 1998, 80(4):492-501.
8.	Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther, 2005, 28(5):345.
9.	Williams BG, Sotereanos DG, Baratz ME, et al. The contracted elbow:is ulnar nerve release necessary? J Shoulder Elbow Surg, 2012, 21(12):1632-1636.
10.	Park MJ, Chang MJ, Lee YB, et al. Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg (Am), 2010, 92(16):2692-2699.
11.	刘珅, 阮洪江, 范存义. 肘关节僵硬治疗中尺神经的处理与预后. 中国矫形外科杂志, 2009, 17(9):707-709.
12.	Ouyang Y, Wang Y, Li F, et al. Open release and a hinged external fixator for the treatment of elbow stiffness in young patients. Orthopedics, 2012, 35(9):e1365-1370.
13.	Liu S, Liu JJ, Li XJ, et al. Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation. J Shoulder Elbow Surg, 2013, 22(2):275-279.
14.	Ouyang Y, Liao Y, Liu Z, et al. Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion. Orthopedics, 2013, 36(2):e186-192.
15.	Ruan HJ, Liu S, Fan CY, et al. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg, 2013, 133(2):179-185.
16.	Wang W, Liu JJ, Liu S, et al. Arthrolysis combined with reconstruction for treatment of terrible triad injury with a poor outcome after surgical as well as conservative intervention. Arch Orthop Trauma Surg, 2014, 134(3):325-331.
17.	公茂琪, 查晔军, 刘兴华, 等. 肘关节松解术治疗创伤后肘关节僵硬:附258例报告. 中华创伤骨科杂志, 2012, 14(2):122-126.
18.	Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med, 1983, 11(5):315-319.
19.	Morrey BF, An KN. Stability of the elbow:osseous constraints. J Shoulder Elbow Surg, 2005, 14(1 Suppl S):174S-178S.
20.	Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res, 1991, (265):187-195.
21.	An KN, Hui FC, Morrey BF, et al. Muscles across the elbow joint:a biomechanical analysis. J Biomech, 1981, 14(10):659-669.
22.	Kulkarni GS, Kulkarni VS, Shyam AK, et al. Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator. J Bone Joint Surg (Br), 2010, 92(1):92-97.
23.	Tan V, Daluiski A, Simic P, et al. Outcome of open release for posttraumatic elbow stiffness. J Trauma, 2006, 61(3):673-678.
24.	Patterson SD, Bain GI, Mehta JA. Surgical approaches to the elbow. Clin Orthop Relat Res, 2000, (370):19-33.
25.	Wang W, Jiang SC, Liu S, et al. Stability of severely stiff elbows after complete open release:treatment by ligament repair with suture anchors and hinged external fixator. J Shoulder Elbow Surg, 2014, 23(10):1537-1544.
26.	Ring D, Hotchkiss RN, Guss D, et al. Hinged elbow external fixation for severe elbow contracture. J Bone Joint Surg (Am), 2005, 87(6):1293-1296.
27.	Morrey BF. Ligament injury and the use of hinged external fixators at the elbow. Instr Course Lect, 2012, 61:215-225.
28.	McCarthy EF, Sundaram M. Heterotopic ossification:a review. Skeletal Radiol, 2005, 34(10):609-619.
29.	Kaplan FS, Glaser DL, Hebela N, et al. Heterotopic ossification. J Am Acad Orthop Surg, 2004, 12(2):116-125.
30.	Lee EK, Namdari S, Hosalkar HS, et al. Clinical results of the excision of heterotopic bone around the elbow:a systematic review. J Shoulder Elbow Surg, 2013, 22(5):716-722.
31.	Lindenhovius AL, Linzel DS, Doornberg JN, et al. Comparison of elbow contracture release in elbows with and without heterotopic ossification restricting motion. J Shoulder Elbow Surg, 2007, 16(5):621-625.
32.	Park MJ, Kim HG, Lee JY. Surgical treatment of post-traumatic stiffness of the elbow. J Bone Joint Surg(Br), 2004, 86(8):1158-1162.
33.	Ilahi OA, Strausser DW, Gabel GT. Post-traumatic heterotopic ossification about the elbow. Orthopedics, 1998, 21(3):265-268.
34.	Bauer AS, Lawson BK, Bliss RL, et al. Risk factors for posttraumatic heterotopic ossification of the elbow:case-control study. J Hand Surg (Am), 2012, 37(7):1422-1429. e1-6.
35.	Douglas K, Cannada LK, Archer KR, et al. Incidence and risk factors of heterotopic ossification following major elbow trauma. Orthopedics, 2012, 35(6):e815-822.
36.	Foruria AM, Augustin S, Morrey BF, et al. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg (Am), 2013, 95(10):e66.
37.	Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal antiinflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol, 2008, 102(1):10-14.
38.	Stein DA, Patel R, Egol KA, et al. Prevention of heterotopic ossification at the elbow following trauma using radiation therapy. Bull Hosp Jt Dis, 2003, 61(3-4):151-154.
39.	张敏, 申文江, 高献书, 等. 肘关节松解术前放射治疗预防异位骨化形成. 国际医学放射学杂志, 2011, 34(3):215-218, 260.
40.	Strauss JB, Wysocki RW, Shah A, et al. Radiation therapy for heterotopic ossification prophylaxis afer high-risk elbow surgery. Am J Orthop (Belle Mead NJ), 2011, 40(8):400-405.
41.	Mansat P, Morrey BF. The column procedure:a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg (Am), 1998, 80(11):1603-1615.
42.	Koh KH, Lim TK, Lee HI, et al. Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Shoulder Elbow Surg, 2013, 22(8):1128-1134.
43.	Yan H, He J, Chen S, et al. Intrawound application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows:a retrospective comparative study. Journal of shoulder and elbow surgery. J Shoulder Elbow Surg, 2014, 23(5):686-692.
44.	Kodde IF, van Rijn J, van den Bekerom MP, et al. Surgical treatment of post-traumatic elbow stiffness:a systematic review. J Shoulder Elbow Surg, 2013, 22(4):574-580.
45.	Issack PS, Egol KA. Posttraumatic contracture of the elbow:current management issues. Bull Hosp Jt Dis, 2006, 63(3-4):129-136.
46.	Sakano S, Hasegawa Y, Murata Y, et al. Inhibitory effect of bFGF on endochondral heterotopic ossification. Biochem Biophys Res Commun, 2002, 293(2):680-685.
47.	Holmenschlager F, Halm JP, Winckler S. Fresh fractures of the radial head:results with the Judet prosthesis. Res Chir Orthop Reparatrice Appar Mot, 2002, 88(4):387-397.
48.	King GJ. Management of comminuted radial head fractures with replacement arthroplasty. Hand Clin, 2004, 20(4):429-441.
49.	Müller MC, Burger C, Wirtz DC, et al. Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis. Oper Orthop Traumatol, 2011, 23(1):37-45.
50.	Giannicola G, Bullitta G, Sacchetti FM, et al. Change in quality of life and cost/utility analysis in open stage-related surgical treatment of elbow stiffness. Orthopedics, 2013, 36(7):e923-930.

1. Keschner MT, Paksima N. The stiff elbow. Bull NYU Hosp Jt Dis, 2007, 65(1):24-28.
2. Morrey BF. Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg (Am), 1990, 72(4):601-618.
3. Higgs ZC, Danks BA, Sibinski M, et al. Outcomes of open arthrolysis of the elbow without post-operative passive stretching. J Bone Joint Surg (Br), 2012, 94(3):348-352.
4. Morrey BF. Surgical treatment of extraarticular elbow contracture. Clin Orthop Relat Res, 2000, (370):57-64.
5. Apfelberg DB, Larson SJ. Dynamic anatomy of the ulnar nerve at the elbow. Plast Reconstr Surg, 1973, 51(1):79-81.
6. Nakano K, Murata K, Omokawa S, et al. Dynamic analysis of the ulnar nerve in the cubital tunnel using ultrasonography. J Shoulder Elbow Surg, 2014, 23(7):933-937.
7. Gelberman RH, Yamaguchi K, Hollstien SB, et al. Changes in interstitial pressure and cross-sectional area of the cubital tunnel and of the ulnar nerve with flexion of the elbow. An experimental study in human cadavera. J Bone Joint Surg (Am), 1998, 80(4):492-501.
8. Robertson C, Saratsiotis J. A review of compressive ulnar neuropathy at the elbow. J Manipulative Physiol Ther, 2005, 28(5):345.
9. Williams BG, Sotereanos DG, Baratz ME, et al. The contracted elbow:is ulnar nerve release necessary? J Shoulder Elbow Surg, 2012, 21(12):1632-1636.
10. Park MJ, Chang MJ, Lee YB, et al. Surgical release for posttraumatic loss of elbow flexion. J Bone Joint Surg (Am), 2010, 92(16):2692-2699.
11. 刘珅, 阮洪江, 范存义. 肘关节僵硬治疗中尺神经的处理与预后. 中国矫形外科杂志, 2009, 17(9):707-709.
12. Ouyang Y, Wang Y, Li F, et al. Open release and a hinged external fixator for the treatment of elbow stiffness in young patients. Orthopedics, 2012, 35(9):e1365-1370.
13. Liu S, Liu JJ, Li XJ, et al. Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation. J Shoulder Elbow Surg, 2013, 22(2):275-279.
14. Ouyang Y, Liao Y, Liu Z, et al. Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion. Orthopedics, 2013, 36(2):e186-192.
15. Ruan HJ, Liu S, Fan CY, et al. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg, 2013, 133(2):179-185.
16. Wang W, Liu JJ, Liu S, et al. Arthrolysis combined with reconstruction for treatment of terrible triad injury with a poor outcome after surgical as well as conservative intervention. Arch Orthop Trauma Surg, 2014, 134(3):325-331.
17. 公茂琪, 查晔军, 刘兴华, 等. 肘关节松解术治疗创伤后肘关节僵硬:附258例报告. 中华创伤骨科杂志, 2012, 14(2):122-126.
18. Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med, 1983, 11(5):315-319.
19. Morrey BF, An KN. Stability of the elbow:osseous constraints. J Shoulder Elbow Surg, 2005, 14(1 Suppl S):174S-178S.
20. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res, 1991, (265):187-195.
21. An KN, Hui FC, Morrey BF, et al. Muscles across the elbow joint:a biomechanical analysis. J Biomech, 1981, 14(10):659-669.
22. Kulkarni GS, Kulkarni VS, Shyam AK, et al. Management of severe extra-articular contracture of the elbow by open arthrolysis and a monolateral hinged external fixator. J Bone Joint Surg (Br), 2010, 92(1):92-97.
23. Tan V, Daluiski A, Simic P, et al. Outcome of open release for posttraumatic elbow stiffness. J Trauma, 2006, 61(3):673-678.
24. Patterson SD, Bain GI, Mehta JA. Surgical approaches to the elbow. Clin Orthop Relat Res, 2000, (370):19-33.
25. Wang W, Jiang SC, Liu S, et al. Stability of severely stiff elbows after complete open release:treatment by ligament repair with suture anchors and hinged external fixator. J Shoulder Elbow Surg, 2014, 23(10):1537-1544.
26. Ring D, Hotchkiss RN, Guss D, et al. Hinged elbow external fixation for severe elbow contracture. J Bone Joint Surg (Am), 2005, 87(6):1293-1296.
27. Morrey BF. Ligament injury and the use of hinged external fixators at the elbow. Instr Course Lect, 2012, 61:215-225.
28. McCarthy EF, Sundaram M. Heterotopic ossification:a review. Skeletal Radiol, 2005, 34(10):609-619.
29. Kaplan FS, Glaser DL, Hebela N, et al. Heterotopic ossification. J Am Acad Orthop Surg, 2004, 12(2):116-125.
30. Lee EK, Namdari S, Hosalkar HS, et al. Clinical results of the excision of heterotopic bone around the elbow:a systematic review. J Shoulder Elbow Surg, 2013, 22(5):716-722.
31. Lindenhovius AL, Linzel DS, Doornberg JN, et al. Comparison of elbow contracture release in elbows with and without heterotopic ossification restricting motion. J Shoulder Elbow Surg, 2007, 16(5):621-625.
32. Park MJ, Kim HG, Lee JY. Surgical treatment of post-traumatic stiffness of the elbow. J Bone Joint Surg(Br), 2004, 86(8):1158-1162.
33. Ilahi OA, Strausser DW, Gabel GT. Post-traumatic heterotopic ossification about the elbow. Orthopedics, 1998, 21(3):265-268.
34. Bauer AS, Lawson BK, Bliss RL, et al. Risk factors for posttraumatic heterotopic ossification of the elbow:case-control study. J Hand Surg (Am), 2012, 37(7):1422-1429. e1-6.
35. Douglas K, Cannada LK, Archer KR, et al. Incidence and risk factors of heterotopic ossification following major elbow trauma. Orthopedics, 2012, 35(6):e815-822.
36. Foruria AM, Augustin S, Morrey BF, et al. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg (Am), 2013, 95(10):e66.
37. Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal antiinflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol, 2008, 102(1):10-14.
38. Stein DA, Patel R, Egol KA, et al. Prevention of heterotopic ossification at the elbow following trauma using radiation therapy. Bull Hosp Jt Dis, 2003, 61(3-4):151-154.
39. 张敏, 申文江, 高献书, 等. 肘关节松解术前放射治疗预防异位骨化形成. 国际医学放射学杂志, 2011, 34(3):215-218, 260.
40. Strauss JB, Wysocki RW, Shah A, et al. Radiation therapy for heterotopic ossification prophylaxis afer high-risk elbow surgery. Am J Orthop (Belle Mead NJ), 2011, 40(8):400-405.
41. Mansat P, Morrey BF. The column procedure:a limited lateral approach for extrinsic contracture of the elbow. J Bone Joint Surg (Am), 1998, 80(11):1603-1615.
42. Koh KH, Lim TK, Lee HI, et al. Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Shoulder Elbow Surg, 2013, 22(8):1128-1134.
43. Yan H, He J, Chen S, et al. Intrawound application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows:a retrospective comparative study. Journal of shoulder and elbow surgery. J Shoulder Elbow Surg, 2014, 23(5):686-692.
44. Kodde IF, van Rijn J, van den Bekerom MP, et al. Surgical treatment of post-traumatic elbow stiffness:a systematic review. J Shoulder Elbow Surg, 2013, 22(4):574-580.
45. Issack PS, Egol KA. Posttraumatic contracture of the elbow:current management issues. Bull Hosp Jt Dis, 2006, 63(3-4):129-136.
46. Sakano S, Hasegawa Y, Murata Y, et al. Inhibitory effect of bFGF on endochondral heterotopic ossification. Biochem Biophys Res Commun, 2002, 293(2):680-685.
47. Holmenschlager F, Halm JP, Winckler S. Fresh fractures of the radial head:results with the Judet prosthesis. Res Chir Orthop Reparatrice Appar Mot, 2002, 88(4):387-397.
48. King GJ. Management of comminuted radial head fractures with replacement arthroplasty. Hand Clin, 2004, 20(4):429-441.
49. Müller MC, Burger C, Wirtz DC, et al. Replacement of the comminuted radial head fracture by a bipolar radial head prosthesis. Oper Orthop Traumatol, 2011, 23(1):37-45.
50. Giannicola G, Bullitta G, Sacchetti FM, et al. Change in quality of life and cost/utility analysis in open stage-related surgical treatment of elbow stiffness. Orthopedics, 2013, 36(7):e923-930.

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