Traumatic elbow stiffness: pathogenic spectrum and comparative outcomes of minimally invasive versus open release surgery.

OBJECTIVE

To identify the predominant pathogenic factors in traumatic elbow stiffness (TES) and to compare functional outcomes between minimally invasive and open release surgery.

METHODS

We retrospectively analyzed 120 patients with TES who were admitted to the HEBEI MEDICAL UNIVERSITY THIRD HOSPITAL between June 2023 and December 2025. Of these, 60 underwent minimally invasive release surgery and 60 underwent open release surgery. Pathogenic causes were determined via preoperative imaging and intraoperative findings. Range of motion (ROM), Mayo Elbow Performance Score (MEPS), and SF-36 were assessed preoperatively and at 6 months.

RESULTS

Ligamentous contracture (91.7%) and heterotopic ossification (80.0%) were the two most common pathologies. The minimally invasive group achieved significantly higher total effectiveness rate (95.0% vs. 83.3%, χ2 = 12.818, P = 0.002), greater gains in extension (Δ34.93° vs. Δ25.41°) and flexion (Δ42.23° vs. Δ22.13°) (both P<0.001), and superior MEPS and SF-36 scores (all P<0.001). Multivariable regression analysis confirmed that surgical approach was an independent predictor of both MEPS total score (β = -9.17, P<0.001) and good clinical outcome (OR = 0.18, P = 0.031).

CONCLUSION

Ligamentous contracture and heterotopic ossification constitute the main treatable targets in TES. Compared with open release surgery, minimally invasive surgery yields better early functional recovery, likely due to reduced iatrogenic trauma and faster rehabilitation. These findings support minimally invasive release surgery as a preferred option for appropriate TES candidates.