This is a Level IV case series of a single surgeon's operative release of complete osseous ankylosis of the elbow. It studied 20 elbows in 15 patients without central nervous system injury, comparing burn-related and trauma-related ankylosis. The question: is surgical release worthwhile and safe, and do results differ by cause?
When you see a completely ankylosed elbow from heterotopic bone in a patient without a brain or spinal cord injury, the message here is that surgery is both safe and worth doing. The headline for boards: burn-related and trauma-related ankylosis achieve comparable motion and functional scores, so a burned arm with bad skin is not a reason to withhold release.
Build your mental model around the operative principles: a combined medial and lateral exposure protects the ulnar and posterior interosseous nerves, manipulation uses minimal force, and if the elbow will not move you release more rather than pushing harder.
Know the two distinct failure patterns. Burn patients recur from capsular and skin contracture, while trauma patients are more likely to reform bone, which is why prophylactic radiation became routine. The practical decision rule: offer a second release to any patient left with less than 80° of ulnohumeral motion.
This is a Level IV case series of a single surgeon's operative release of complete osseous ankylosis of the elbow. It studied 20 elbows in 15 patients without central nervous system injury, comparing burn-related and trauma-related ankylosis. The question: is surgical release worthwhile and safe, and do results differ by cause?
When you see a completely ankylosed elbow from heterotopic bone in a patient without a brain or spinal cord injury, the message here is that surgery is both safe and worth doing. The headline for boards: burn-related and trauma-related ankylosis achieve comparable motion and functional scores, so a burned arm with bad skin is not a reason to withhold release.
Build your mental model around the operative principles: a combined medial and lateral exposure protects the ulnar and posterior interosseous nerves, manipulation uses minimal force, and if the elbow will not move you release more rather than pushing harder.
Know the two distinct failure patterns. Burn patients recur from capsular and skin contracture, while trauma patients are more likely to reform bone, which is why prophylactic radiation became routine. The practical decision rule: offer a second release to any patient left with less than 80° of ulnohumeral motion.