JBJS essential surgical techniques · 2011
Operative Treatment of Elbow Stiffness.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Ring David, Jupiter Jesse B
Аннотация
INTRODUCTION: Open elbow contracture release is the mainstay for the operative treatment of posttraumatic elbow stiffness.
STEP 1 SKIN INCISION: Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions.
STEP 2 PROTECT OR RELEASE PERIPHERAL NERVES: Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used.
STEP 3 DEVELOP MUSCLE INTERVALS FOR EXPOSURE OF THE JOINT: Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule.
STEP 4 RESECT BONE CONTRACTED CAPSULE AND IMPLANTS RESTRICTING MOTION: Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule.
STEP 5 TENOLYSIS/MUSCLE ELEVATION: When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator.
STEP 6 MANIPULATE ELBOW CONSIDER IMPLANT REMOVAL: Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants.
STEP 7 WOUND CLOSURE: Close the muscle intervals and skin.
STEP 8 POSTOPERATIVE MANAGEMENT: The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches.
RESULTS: A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°.
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.
STEP 1 SKIN INCISION: Use either a posterior skin incision and raise medial and lateral skin flaps or use more direct individual medial and lateral skin incisions.
STEP 2 PROTECT OR RELEASE PERIPHERAL NERVES: Release the ulnar nerve using a small incision and in situ release when a lateral muscle interval (between the extensor carpi radialis brevis and extensor digitorum communis muscles) is preferred for the contracture release; use a larger incision with subcutaneous anterior transposition when a medial muscle interval (50:50 split of the flexor pronator mass) is used.
STEP 3 DEVELOP MUSCLE INTERVALS FOR EXPOSURE OF THE JOINT: Choose a lateral (extensor carpi radialis brevis/extensor digitorum communis) or medial (50:50 split of the flexor pronator mass) muscle interval to expose the elbow capsule.
STEP 4 RESECT BONE CONTRACTED CAPSULE AND IMPLANTS RESTRICTING MOTION: Remove the structures that hinder motion: implants, heterotopic bone, and contracted capsule.
STEP 5 TENOLYSIS/MUSCLE ELEVATION: When the triceps and the brachialis muscles are adherent to the distal third of the humerus, release them using an elevator.
STEP 6 MANIPULATE ELBOW CONSIDER IMPLANT REMOVAL: Take care not to push so hard that you fracture the bone at a stress riser created by removal of bone or implants.
STEP 7 WOUND CLOSURE: Close the muscle intervals and skin.
STEP 8 POSTOPERATIVE MANAGEMENT: The key after surgery is frequent, active, patient-assisted elbow flexion, extension, and forearm rotation stretches.
RESULTS: A case series of patients with elbow contracture release documented an average improvement in the arc of elbow flexion of between 21° and 66°.
WHAT TO WATCH FOR: IndicationsContraindicationsPitfalls & Challenges.