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Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach

Objective  To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods  A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The a...

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Autores principales: Gracitelli, Mauro E.C., Guglielmetti, César L.B., Botelho, Caio A.S., Malavolta, Eduardo A., Assunção, Jorge H., Ferreira Neto, Arnaldo A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda 2020
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575365/
https://www.ncbi.nlm.nih.gov/pubmed/33093721
http://dx.doi.org/10.1055/s-0039-1700827
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author Gracitelli, Mauro E.C.
Guglielmetti, César L.B.
Botelho, Caio A.S.
Malavolta, Eduardo A.
Assunção, Jorge H.
Ferreira Neto, Arnaldo A.
author_facet Gracitelli, Mauro E.C.
Guglielmetti, César L.B.
Botelho, Caio A.S.
Malavolta, Eduardo A.
Assunção, Jorge H.
Ferreira Neto, Arnaldo A.
author_sort Gracitelli, Mauro E.C.
collection PubMed
description Objective  To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods  A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results  A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period ( p  < 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% ( p  < 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° ( p  < 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively ( p  < 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively ( p  < 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period ( p  = 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions  The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.
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spelling pubmed-75753652020-10-21 Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach Gracitelli, Mauro E.C. Guglielmetti, César L.B. Botelho, Caio A.S. Malavolta, Eduardo A. Assunção, Jorge H. Ferreira Neto, Arnaldo A. Rev Bras Ortop (Sao Paulo) Objective  To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods  A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results  A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period ( p  < 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% ( p  < 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° ( p  < 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively ( p  < 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively ( p  < 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period ( p  = 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions  The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications. Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda 2020-10 2020-01-09 /pmc/articles/PMC7575365/ /pubmed/33093721 http://dx.doi.org/10.1055/s-0039-1700827 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ). https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Gracitelli, Mauro E.C.
Guglielmetti, César L.B.
Botelho, Caio A.S.
Malavolta, Eduardo A.
Assunção, Jorge H.
Ferreira Neto, Arnaldo A.
Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title_full Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title_fullStr Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title_full_unstemmed Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title_short Surgical Treatment of Post-traumatic Elbow Stiffness by Wide Posterior Approach
title_sort surgical treatment of post-traumatic elbow stiffness by wide posterior approach
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575365/
https://www.ncbi.nlm.nih.gov/pubmed/33093721
http://dx.doi.org/10.1055/s-0039-1700827
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