Elbow Dislocations, Instability and Contracture-Case: Vignette

Case: Vignette

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Summary:<br /><br />A 23-year-old female presented with stiffness and numbness in her right elbow, five months after undergoing surgery for a distal humerus fracture. She had previously tried anti-inflammatories and physical therapy. Physical examination revealed limited range of motion and positive signs for ulnar nerve compression.<br /><br />The questions that were addressed included the role of non-operative management, the timing of surgical intervention, principles of elbow release, negative prognostic factors, and recommended pre-operative imaging.<br /><br />The management plan included surgical removal of hardware, radical capsulectomy, ulnar nerve release, and revision fixation. The timing of surgery is based on the plateau of range of motion and the resolution of soft tissue inflammation.<br /><br />Non-operative measures such as splinting and physical therapy were suggested as initial treatment options, with surgery reserved for cases with limited range of motion. Contraindications for surgery were primary osteoarthritis and extensive heterotopic ossification.<br /><br />Principles of elbow release involve improving motion while maintaining stability. Flexion deficits are addressed by releasing posterior tethers and removing anterior impingement, and extension deficits are treated by releasing anterior tethers and removing posterior impingement.<br /><br />Negative prognostic factors were identified as adolescents and traumatic brain injury. Pre-operative imaging included radiographs and computed tomography for planning.<br /><br />Open versus arthroscopic release was discussed, with surgeon preference playing a role. Different approaches for open elbow release were described, with the posterior approach being the most common. Ulnar nerve release was recommended for patients with ulnar neuritis or significant loss of elbow flexion.<br /><br />In conclusion, non-operative management and physical therapy should be attempted initially. Surgery may be considered when conservative measures are unsuccessful, and the timing is determined by the plateau of range of motion and resolution of soft tissue inflammation. The principles of elbow release involve addressing flexion and extension deficits, and specific factors can influence the prognosis and surgical approach.

Keywords

elbow stiffness

ulnar nerve compression

surgical intervention timing

soft tissue inflammation

flexion deficits

extension deficits

negative prognostic factors

pre-operative imaging

open elbow release

ulnar neuritis