Elbow Kinematics and Function Following Treatment with Open Arthrolysis and Hinged External Fixator

作者：Ling, Ming; Liang, Zhenming; Wang, Yanmao; Cheng, Mengqi; Lu, Shengdi; Pan, Yao; Hu, Hai; Chen, Bin; Ding, Jian^*

来源：Orthopaedic Surgery, 2023, 15(8): 2102-2109.

DOI：10.1111/os.13714

• Ankylosis
• Elbow
• External fixator
• Kinematics

Objective: Open arthrolysis (OA) combined with hinged external fixator (HEF) is a promising surgical option for patients with elbow stiffness. This study aimed to investigate elbow kinematics and function following a combined treatment with OA and HEF in elbow stiffness cases.Methods: Patients treated with OA with or without HEF due to elbow stiffness were recruited between August 2017 and July 2019. Elbow flexion-extension motion and Mayo elbow performance scores, MEPS) were recorded and compared between patients with and without HEF during a 1-year follow-up period. Additionally, those with HEF were assessed by dual fluoroscopy at week 6 postoperatively. Flexion-extension and varus-valgus motions, as well as ligament insertion distances of the anterior medial collateral ligament (AMCL) and lateral ulnar collateral ligament (LUCL), were compared between the surgical and intact sides.Results: This study included 42 patients, of which 12 with HEF demonstrated a similar flexion-extension angle and range of motion (ROM) and MEPS as the other patients. In patients with HEF, the surgical elbows showed limitations in flexion-extension (maximal flexion, 120.5?degrees +/- 5.3?degrees vs 140.4?degrees +/- 6.8?degrees; maximal extension, 13.1?degrees +/- 6.0?degrees vs 6.4?degrees +/- 3.0?degrees; ROM, 107.4?degrees +/- 9.9?degrees vs 134.0?degrees +/- 6.8?degrees; all Ps < 0.01) compared with the contralateral sides. During elbow flexion, a gradual valgus-to-varus transition of the ulna, increase in the AMCL insertion distance, and steady change in the LUCL insertion distance were observed, with no significant differences between the bilateral sides.Conclusions: Patients treated with OA and HEF demonstrated similar elbow flexion-extension motion and function to those treated with OA alone. Although the use of HEF could not restore an intact flexion-extension ROM and might result in some minor but not significant changes in kinematics, it contributed to clinical outcomes comparable to that of the treatment with OA alone.

• 单位
  南方医科大学; 6; 广东医学院; 复旦大学; 上海交通大学