This retrospective series describes a modified lateral (extended Kocher) approach for releasing post-traumatic elbow contracture. The technique spares the lateral collateral ligament and extensor origin, unlike the authors' prior approach that detached them. The question: can contracture be corrected safely and effectively without violating the lateral stabilizers?
The decision rule here is anatomic: work proximal to the conjoined lateral collateral and annular ligament complex, and you can debride the entire anterior and posterior elbow through one lateral incision without creating instability.
The authors' own prior technique detached the ligament and extensor origin, then reattached them. Two patients avulsed that repair and developed posterolateral rotatory instability needing revision. This paper is the correction of that pitfall.
Preserving the ligament pays off twice. First, no instability. Second, no protective bracing, so rehabilitation is unrestricted from day one, which matters because motion can improve for three to four months.
Watch the ulnar nerve. As flexion improves, ulnar tension rises and 3 of 22 developed transient neuritis. Release and transpose the nerve if the patient has symptoms or a positive Tinel or flexion test. Select patients carefully: the joint must be congruous with an adequate humeroulnar space.
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This retrospective series describes a modified lateral (extended Kocher) approach for releasing post-traumatic elbow contracture. The technique spares the lateral collateral ligament and extensor origin, unlike the authors' prior approach that detached them. The question: can contracture be corrected safely and effectively without violating the lateral stabilizers?
The decision rule here is anatomic: work proximal to the conjoined lateral collateral and annular ligament complex, and you can debride the entire anterior and posterior elbow through one lateral incision without creating instability.
The authors' own prior technique detached the ligament and extensor origin, then reattached them. Two patients avulsed that repair and developed posterolateral rotatory instability needing revision. This paper is the correction of that pitfall.
Preserving the ligament pays off twice. First, no instability. Second, no protective bracing, so rehabilitation is unrestricted from day one, which matters because motion can improve for three to four months.
Watch the ulnar nerve. As flexion improves, ulnar tension rises and 3 of 22 developed transient neuritis. Release and transpose the nerve if the patient has symptoms or a positive Tinel or flexion test. Select patients carefully: the joint must be congruous with an adequate humeroulnar space.