ELBOW ARTHROLYSIS VIA THE TRANSHUMERAL APPROACH: THIRTEEN CASES

Abstract

Purpose: The approach chosen for total elbow arthrolysis is crucial. It should allow access to all lesions causing joint stiffness yet avoid excessive mutilation. We report our experience with the transhumeral approach respecting the lateral structures.

Material and methods: Thirteen transhumeral elbow arthrolyses were performed from 1996 to 2002 and reviewed retrospectively at mean 18 months (6–63). Mean age at surgery was 44 years. Stiffness resulted from trauma in five patients and degenerative disease in eight. The SOFCOT classification was severe in two, moderate in ten and minimal in one. Arthroysis was performed by the posterior transtricipital technique. After releasing the fossa and the olecranon beak, the coronoid process and the anterior capsule were released using a transhumeral bone window. Two patients also underwent ulnar nerve transposition. Rehabilitation was initiated early and continued for 17 weeks on average.

Results: At last follow-up, active elbow extension improved from −39±9° to 21±9° and flexion from 109±14° to 129±7°, corresponding to an increase in motion of 38±14° (70° preoperatively and 108° postoperatively). This gain in motion was the same in the trauma and degeneration groups. Pain, evaluated with a visual analogue scale from 0 to 10 improved from 3.2±1.3 to 2.4±2.0 for posttraumatic stiffness and from 7.4±1.3 to 4.1±2.0 for degenerative stiffness. There was on postoperative irritation of the ulnar nerve which regressed partially.

Discussion: Transhumeral arthrolysis allows posterior and anterior release while preserving the lateral structures. This technique has been very effective for olecranon bone blockage, posterior and anterior capsule retraction, and for coronoid anterior block. For degenerative elbows, pain relief was achieved in 70%.

Conclusion: Transhumeral elbow arthrolysis initially proposed for the degenerative elbow can be used for posttraumatic stiffness in patients with a moderate form without limiting pronosupination nor injuring the lateral ligaments. The best indication is fracture of the humeral plate.