Skip to main content
Top
Published in: BMC Musculoskeletal Disorders 1/2016

Open Access 01-12-2016 | Research article

Open arthrolysis for elbow stiffness increases carrying angle but has no impact on functional recovery

Authors: Dapeng Fan, Wei Wang, Kevin A. Hildebrand, Cun-yi Fan

Published in: BMC Musculoskeletal Disorders | Issue 1/2016

Login to get access

Abstract

Background

With the exception of normal anatomic changes in the medial collateral ligament and radial head, other factors related to carrying angle changes have not been systematically studied. We reviewed patients who underwent open arthrolysis of the elbow, and evaluated if open arthrolysis could change carrying angle. We then identified factors associated with carrying angle changes.

Methods

Fifty patients with a minimum of 24 months of follow-up after open arthrolysis were evaluated retrospectively. Preoperative and postoperative carrying angles were compared.

Results

The carrying angles of 36 elbows in 36 patients were unchanged after surgery (Group A), while the carrying angles of 14 elbows in 14 patients increased postoperatively (Group B). In Group A, mean postoperative extension and flexion were 7° (range 0–24°) and 125° (range 10–135°) respectively, while mean postoperative pronation and supination were 60° (range 50–80°) and 65° (range 30–85°), respectively. In Group B, mean postoperative extension and flexion were 25° (range 0–40°) and 128° (range 60–138°), while mean postoperative pronation and supination were 65° (range 45–85°) and 60° (range 45–75°), respectively. No significant difference in range of motion and Mayo Elbow Performance Score was observed between the two groups.

Conclusions

During open arthrolysis, humeral trochlea debridement and techniques for improving forearm rotation could increase carrying angle. However, this had no impact on elbow functional recovery.
Literature
1.
go back to reference An KN, Hui FC, Morrey BF, Linscheid RL, Chao EY. Muscles across the elbow joint: a biomechanical analysis. J Biomech. 1981;14(10):659–69.CrossRefPubMed An KN, Hui FC, Morrey BF, Linscheid RL, Chao EY. Muscles across the elbow joint: a biomechanical analysis. J Biomech. 1981;14(10):659–69.CrossRefPubMed
2.
go back to reference Yilmaz E, Karakurt L, Belhan O, Bulut M, Serin E, Avci M. Variation of carrying angle with age, sex, and special reference to side. Orthopedics. 2005;28(11):1360–3.PubMed Yilmaz E, Karakurt L, Belhan O, Bulut M, Serin E, Avci M. Variation of carrying angle with age, sex, and special reference to side. Orthopedics. 2005;28(11):1360–3.PubMed
3.
go back to reference Paraskevas G, Papadopoulos A, Papaziogas B, Spanidou S, Argiriadou H, Gigis J. Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis. Surg Radiol Anat. 2004;26(1):19–23.CrossRefPubMed Paraskevas G, Papadopoulos A, Papaziogas B, Spanidou S, Argiriadou H, Gigis J. Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis. Surg Radiol Anat. 2004;26(1):19–23.CrossRefPubMed
4.
go back to reference Sharma K, Mansur DI, Khanal K, Haque MK. Variation of carrying angle with age, sex, height and special reference to side. Kathmandu Univ Med J (KUMJ). 2013;11(44):315–8. Sharma K, Mansur DI, Khanal K, Haque MK. Variation of carrying angle with age, sex, height and special reference to side. Kathmandu Univ Med J (KUMJ). 2013;11(44):315–8.
5.
go back to reference Zampagni ML, Casino D, Zaffagnini S, Visani A, Marcacci M. Trend of the carrying angle during flexion-extension of the elbow joint: a pilot study. Orthopedics. 2008;31(1):76.CrossRefPubMed Zampagni ML, Casino D, Zaffagnini S, Visani A, Marcacci M. Trend of the carrying angle during flexion-extension of the elbow joint: a pilot study. Orthopedics. 2008;31(1):76.CrossRefPubMed
6.
7.
go back to reference Mehlman CT, Crawford AH, Mcmillion TL, Roy DR. Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg. 1996;62 Suppl 1:41–50.PubMed Mehlman CT, Crawford AH, Mcmillion TL, Roy DR. Operative treatment of supracondylar fractures of the humerus in children: the Cincinnati experience. Acta Orthop Belg. 1996;62 Suppl 1:41–50.PubMed
8.
go back to reference Everding NG, Maschke SD, Hoyen HA, Evans PJ. Prevention and treatment of elbow stiffness: a 5-year update. J Hand Surg [Am]. 2013;38(12):2496–507. quiz 2507.CrossRef Everding NG, Maschke SD, Hoyen HA, Evans PJ. Prevention and treatment of elbow stiffness: a 5-year update. J Hand Surg [Am]. 2013;38(12):2496–507. quiz 2507.CrossRef
9.
go back to reference Bruno RJ, Lee ML, Strauch RJ, Rosenwasser MP. Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg. 2002;10(2):106–16.CrossRefPubMed Bruno RJ, Lee ML, Strauch RJ, Rosenwasser MP. Posttraumatic elbow stiffness: evaluation and management. J Am Acad Orthop Surg. 2002;10(2):106–16.CrossRefPubMed
10.
go back to reference Myden C, Hildebrand K. Elbow joint contracture after traumatic injury. J Shoulder Elbow Surg. 2011;20(1):39–44.CrossRefPubMed Myden C, Hildebrand K. Elbow joint contracture after traumatic injury. J Shoulder Elbow Surg. 2011;20(1):39–44.CrossRefPubMed
11.
go back to reference Ouyang Y, Liao Y, Liu Z, Fan C. Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion. Orthopedics. 2013;36(2):e186–92.CrossRefPubMed Ouyang Y, Liao Y, Liu Z, Fan C. Hinged external fixator and open surgery for severe elbow stiffness with distal humeral nonunion. Orthopedics. 2013;36(2):e186–92.CrossRefPubMed
12.
go back to reference Wang W, Jiang SC, Liu S, Ruan HJ, Fan CY. 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):1537–44.CrossRefPubMed Wang W, Jiang SC, Liu S, Ruan HJ, Fan CY. 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):1537–44.CrossRefPubMed
13.
go back to reference Ruan HJ, Liu S, Fan CY, Liu JJ. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg. 2013;133(2):179–85.CrossRefPubMed Ruan HJ, Liu S, Fan CY, Liu JJ. Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg. 2013;133(2):179–85.CrossRefPubMed
14.
go back to reference Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D. Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg. 2013;22(4):574–80.CrossRefPubMed Kodde IF, van Rijn J, van den Bekerom MP, Eygendaal D. Surgical treatment of post-traumatic elbow stiffness: a systematic review. J Shoulder Elbow Surg. 2013;22(4):574–80.CrossRefPubMed
15.
go back to reference Valero Gonzalez FS, Gutierrez Sevilla GR, Aguilera Zepeda JM, Encalada-Diaz MI, Ruiz-Suarez M. [Open surgical treatment in post-traumatic elbow stiffness]. Acta Ortop Mex. 2008;22(4):228–32.PubMed Valero Gonzalez FS, Gutierrez Sevilla GR, Aguilera Zepeda JM, Encalada-Diaz MI, Ruiz-Suarez M. [Open surgical treatment in post-traumatic elbow stiffness]. Acta Ortop Mex. 2008;22(4):228–32.PubMed
16.
17.
go back to reference Morrey BF, Tanaka S, An KN. Valgus stability of the elbow a definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;265:187–95. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow a definition of primary and secondary constraints. Clin Orthop Relat Res. 1991;265:187–95.
18.
go back to reference Sun Y, Cai J, Li F, Liu S, Ruan H, Fan C. The efficacy of celecoxib in preventing heterotopic ossification recurrence after open arthrolysis for post-traumatic elbow stiffness in adults. J Shoulder Elbow Surg. 2015;24(11):1735–40.CrossRefPubMed Sun Y, Cai J, Li F, Liu S, Ruan H, Fan C. The efficacy of celecoxib in preventing heterotopic ossification recurrence after open arthrolysis for post-traumatic elbow stiffness in adults. J Shoulder Elbow Surg. 2015;24(11):1735–40.CrossRefPubMed
19.
go back to reference Liu S, Liu JJ, Li XJ, Ruan HJ, Fan CY. Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation. J Shoulder Elbow Surg. 2013;22(2):275–9.CrossRefPubMed Liu S, Liu JJ, Li XJ, Ruan HJ, Fan CY. Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation. J Shoulder Elbow Surg. 2013;22(2):275–9.CrossRefPubMed
20.
go back to reference Ulmar B, Eschler A, Mittlmeier T. [Open arthrolysis of elbow stiffness]. Unfallchirurg. 2012;115(8):725–37. quiz 738.CrossRefPubMed Ulmar B, Eschler A, Mittlmeier T. [Open arthrolysis of elbow stiffness]. Unfallchirurg. 2012;115(8):725–37. quiz 738.CrossRefPubMed
21.
go back to reference Ayadi D, Etienne P, Burny F, Schuind F. Results of open arthrolysis for elbow stiffness. A series of 22 cases. Acta Orthop Belg. 2011;77(4):453–7.PubMed Ayadi D, Etienne P, Burny F, Schuind F. Results of open arthrolysis for elbow stiffness. A series of 22 cases. Acta Orthop Belg. 2011;77(4):453–7.PubMed
22.
go back to reference An KN, Morrey BF, Chao EY. Carrying angle of the human elbow joint. J Orthop Res. 1984;1(4):369–78.CrossRefPubMed An KN, Morrey BF, Chao EY. Carrying angle of the human elbow joint. J Orthop Res. 1984;1(4):369–78.CrossRefPubMed
23.
go back to reference Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.CrossRefPubMed Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. Am J Sports Med. 1983;11(5):315–9.CrossRefPubMed
24.
go back to reference Morrey BF, An KN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg. 2005;14(1 Suppl S):174S–8.CrossRefPubMed Morrey BF, An KN. Stability of the elbow: osseous constraints. J Shoulder Elbow Surg. 2005;14(1 Suppl S):174S–8.CrossRefPubMed
25.
go back to reference Heim U. Kombinierte verletzungen von radius and ulnar in proximalen unteram segment. Hefte Unfallechir. 1994;241:61–79.CrossRef Heim U. Kombinierte verletzungen von radius and ulnar in proximalen unteram segment. Hefte Unfallechir. 1994;241:61–79.CrossRef
26.
go back to reference Abbassi N, Abdeljaouad N, Daoudi A, Yacoubi H. Isolated fracture of the humeral trochlea: a case report and review of the literature. J Med Case Rep. 2015;9:121.CrossRefPubMedPubMedCentral Abbassi N, Abdeljaouad N, Daoudi A, Yacoubi H. Isolated fracture of the humeral trochlea: a case report and review of the literature. J Med Case Rep. 2015;9:121.CrossRefPubMedPubMedCentral
27.
go back to reference Zimmerman LJ, Jauregui JJ, Aarons CE. Isolated shear fracture of the humeral trochlea in an adolescent: a case report and literature review. J Pediatr Orthop B. 2015;24(5):412–7.CrossRefPubMed Zimmerman LJ, Jauregui JJ, Aarons CE. Isolated shear fracture of the humeral trochlea in an adolescent: a case report and literature review. J Pediatr Orthop B. 2015;24(5):412–7.CrossRefPubMed
28.
go back to reference Pomianowski S, O'Driscoll SW, Neale PG, Park MJ, Morrey BF, An KN. The effect of forearm rotation on laxity and stability of the elbow. Clin Biomech (Bristol, Avon). 2001;16(5):401–7.CrossRef Pomianowski S, O'Driscoll SW, Neale PG, Park MJ, Morrey BF, An KN. The effect of forearm rotation on laxity and stability of the elbow. Clin Biomech (Bristol, Avon). 2001;16(5):401–7.CrossRef
29.
go back to reference Wening JV, Wobig B, Jungbluth KH. Resection of the radius head in multiple and comminuted fractures. Clinical results and critical evaluation compared with the literature. Unfallchirurgie. 1993;19(3):175–82.CrossRefPubMed Wening JV, Wobig B, Jungbluth KH. Resection of the radius head in multiple and comminuted fractures. Clinical results and critical evaluation compared with the literature. Unfallchirurgie. 1993;19(3):175–82.CrossRefPubMed
30.
go back to reference Naito A, Shimizu Y, Handa Y, Ichie M, Hoshimiya N. Functional anatomical studies of the elbow movements. I. Electromyographic (EMG) analysis. Okajimas Folia Anat Jpn. 1991;68(5):283–8.CrossRefPubMed Naito A, Shimizu Y, Handa Y, Ichie M, Hoshimiya N. Functional anatomical studies of the elbow movements. I. Electromyographic (EMG) analysis. Okajimas Folia Anat Jpn. 1991;68(5):283–8.CrossRefPubMed
31.
go back to reference Ibanez-Gimeno P, Galtes I, Jordana X, Malgosa A, Manyosa J. Biomechanics of forearm rotation: force and efficiency of pronator teres. PLoS One. 2014;9(2):e90319.CrossRefPubMedPubMedCentral Ibanez-Gimeno P, Galtes I, Jordana X, Malgosa A, Manyosa J. Biomechanics of forearm rotation: force and efficiency of pronator teres. PLoS One. 2014;9(2):e90319.CrossRefPubMedPubMedCentral
32.
go back to reference Basmajian JV, Latif A. Integrated actions and functions of the chief flexors of the elbow: a detailed electromyographic analysis. J Bone Joint Surg Am. 1957;39-A(5):1106–18.CrossRefPubMed Basmajian JV, Latif A. Integrated actions and functions of the chief flexors of the elbow: a detailed electromyographic analysis. J Bone Joint Surg Am. 1957;39-A(5):1106–18.CrossRefPubMed
Metadata
Title
Open arthrolysis for elbow stiffness increases carrying angle but has no impact on functional recovery
Authors
Dapeng Fan
Wei Wang
Kevin A. Hildebrand
Cun-yi Fan
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2016
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-016-1205-6

Other articles of this Issue 1/2016

BMC Musculoskeletal Disorders 1/2016 Go to the issue