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Cunyi Fan - One of the best experts on this subject based on the ideXlab platform.
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midterm outcomes after open Arthrolysis for posttraumatic elbow stiffness in children and adolescents
Journal of Pediatric Orthopaedics, 2021Co-Authors: Jihao Ruan, Cunyi Fan, Ziyang Sun, Haomin Cui, Shuai Chen, Wei WangAbstract:BACKGROUND Open Arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open Arthrolysis in children and adolescents with posttraumatic elbow stiffness. METHODS Data of 31 children and adolescents with posttraumatic elbow stiffness following open Arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables. RESULTS The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy. CONCLUSIONS Most patients showed satisfactory functional outcomes after Arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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open elbow Arthrolysis for post traumatic elbow stiffness an update
Bone & joint open, 2020Co-Authors: Ziyang Sun, Weixuan Liu, Cunyi FanAbstract:Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow Arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent Arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, Arthrolysis strategies, postoperative rehabilitation, and prevention of complications, aiming to provide a complete diagnosis and treatment path. Cite this article: Bone Joint Open 2020;1-9:576-584.
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effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open Arthrolysis combined with hinged external fixation a retrospective study
Journal of Shoulder and Elbow Surgery, 2020Co-Authors: Hao Xiong, Ziyang Sun, Shuai Chen, Wei Wang, Wenjun Liu, Shiqiao Peng, Cunyi FanAbstract:BACKGROUND Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow Arthrolysis. METHODS The study included 131 patients with post-traumatic elbow stiffness who underwent Arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 μmol/L), 34 in Q2 (293-348 μmol/L), 32 in Q3 (348-441 μmol/L), and 32 in Q4 (441-710 μmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after Arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.
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what range of motion and functional results can be expected after open Arthrolysis with hinged external fixation for severe posttraumatic elbow stiffness
Clinical Orthopaedics and Related Research, 2019Co-Authors: Ziyang Sun, Haomin Cui, Wei Wang, Jihao Ruan, Cunyi FanAbstract:Background The elbow is more susceptible to loss of motion after trauma than any other joint. Open Arthrolysis often is performed for posttraumatic elbow stiffness if the stiffness does not improve with nonsurgical treatment, but the midterm results of this procedure and factors that may limit recovery have not been widely studied. Questions/purposes We reviewed patients who had undergone open Arthrolysis with hinged external fixator for severe posttraumatic elbow stiffness (ROM ≤ 60°) with a minimum of 5 years followup to (1) analyze ROM gains; (2) assess functional improvement with the Mayo Elbow Performance Index (MEPI) and DASH, quality of life with the SF-36, pain with VAS, and ulnar nerve function with the Amadio rating scale and Dellon classification; and (3) identify complications and risk factors that might hinder mid-term elbow motion recovery after this procedure. Methods Between March 2011 and December 2012, we generally offered patients with elbow stiffness an open Arthrolysis procedure when function did not improve with 6 months of nonoperative therapy, and no contraindications such as immature heterotopic ossification or complete destruction of articular cartilage were present. During that time, 161 patients underwent open Arthrolysis for posttraumatic elbow stiffness at our institution; 49 of them satisfied the study inclusion criteria (adults with elbow ROM ≤ 60° as a result of trauma) and exclusion criteria (stiffness caused by burns or central nervous system injuries, causative trauma associated with nonunion or malunion of the elbow, severe articular damage that would have necessitated joint arthroplasty, or prior elbow release). In general, a combined medial-lateral approach to the elbow was performed to address the soft tissue tethers and any blocks to elbow motion, and a hinged external fixator was applied for 6 weeks to maintain elbow stability and improve the efficacy of postoperative rehabilitation. These patients were evaluated retrospectively at a mean followup period of 69 months (range, 62-83 months), and demographics, disease characteristics, Arthrolysis details, pre- and postoutcome measures as noted, and complications were recorded via an electronic database. Multivariate regression analysis was performed to identify factors associated with ROM recovery. Results At final followup, total ROM increased from a preoperative mean of 27 ± 20° to a postoperative mean of 131 ± 11° (mean difference, 104°; 95% CI, 98°-111°; p 120° (n = 40). After controlling for potential confounding variables such as duration of stiffness and tobacco use, we found that tobacco use was the only independent risk factor examined (odds ratio, 9; 95% CI, 2-47; p = 0.009) associated with recovery of ROM. Conclusions Satisfactory medium-term results were found for open Arthrolysis with hinged external fixation with our protocol in patients who had severe posttraumatic elbow stiffness. Appropriate and sufficient releases of tethered soft tissues and correction of any blocks that affect elbow motion intraoperatively, a dedicated team approach, and an aggressive and systematic postoperative rehabilitation program are the core steps for this procedure. Additionally, the importance of preoperative discontinuation of tobacco use should be emphasized. Level of evidence Level IV, therapeutic study.
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the current state and prospect of open elbow Arthrolysis for post traumatic elbow stiffness
Chinese Journal of Orthopaedic Trauma, 2019Co-Authors: Ziyang Sun, Feiyan Wang, Haomin Cui, Shuai Chen, Hao Xiong, Wei Wang, Cunyi FanAbstract:The elbow is more susceptible to motion loss than other joints after trauma, and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities. Open Arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness. In this paper, we review the treatment protocols like preoperative clinical evaluation, Arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness, discuss relevant issues and assess their prospects. Key words: Trauma; Elbow joints; Stiffness; Preoperative evaluation; Arthrolysis; Heterotopic ossification
Y Allieu - One of the best experts on this subject based on the ideXlab platform.
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elbow Arthrolysis via the transhumeral approach thirteen cases
Orthopaedic Proceedings, 2018Co-Authors: B Coulet, Michel Chammas, B Martin, F Buscayret, Y AllieuAbstract:Purpose: The approach chosen for total elbow Arthrolysis is crucial. It should allow access to all lesions causing joint stiffness yet avoid excessive mutilation. We report our experience with the transhumeral approach respecting the lateral structures.Material and methods: Thirteen transhumeral elbow arthrolyses were performed from 1996 to 2002 and reviewed retrospectively at mean 18 months (6–63). Mean age at surgery was 44 years. Stiffness resulted from trauma in five patients and degenerative disease in eight. The SOFCOT classification was severe in two, moderate in ten and minimal in one. Arthroysis was performed by the posterior transtricipital technique. After releasing the fossa and the olecranon beak, the coronoid process and the anterior capsule were released using a transhumeral bone window. Two patients also underwent ulnar nerve transposition. Rehabilitation was initiated early and continued for 17 weeks on average.Results: At last follow-up, active elbow extension improved from −39±9° to 21±...
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elbow Arthrolysis via the transhumeral approach thirteen cases
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: B Coulet, Michel Chammas, B Martin, F Buscayret, Y AllieuAbstract:Purpose: The approach chosen for total elbow Arthrolysis is crucial. It should allow access to all lesions causing joint stiffness yet avoid excessive mutilation. We report our experience with the transhumeral approach respecting the lateral structures. Material and methods: Thirteen transhumeral elbow arthrolyses were performed from 1996 to 2002 and reviewed retrospectively at mean 18 months (6–63). Mean age at surgery was 44 years. Stiffness resulted from trauma in five patients and degenerative disease in eight. The SOFCOT classification was severe in two, moderate in ten and minimal in one. Arthroysis was performed by the posterior transtricipital technique. After releasing the fossa and the olecranon beak, the coronoid process and the anterior capsule were released using a transhumeral bone window. Two patients also underwent ulnar nerve transposition. Rehabilitation was initiated early and continued for 17 weeks on average. Results: At last follow-up, active elbow extension improved from −39±9° to 21±9° and flexion from 109±14° to 129±7°, corresponding to an increase in motion of 38±14° (70° preoperatively and 108° postoperatively). This gain in motion was the same in the trauma and degeneration groups. Pain, evaluated with a visual analogue scale from 0 to 10 improved from 3.2±1.3 to 2.4±2.0 for posttraumatic stiffness and from 7.4±1.3 to 4.1±2.0 for degenerative stiffness. There was on postoperative irritation of the ulnar nerve which regressed partially. Discussion: Transhumeral Arthrolysis allows posterior and anterior release while preserving the lateral structures. This technique has been very effective for olecranon bone blockage, posterior and anterior capsule retraction, and for coronoid anterior block. For degenerative elbows, pain relief was achieved in 70%. Conclusion: Transhumeral elbow Arthrolysis initially proposed for the degenerative elbow can be used for posttraumatic stiffness in patients with a moderate form without limiting pronosupination nor injuring the lateral ligaments. The best indication is fracture of the humeral plate.
Mervyn J Cross - One of the best experts on this subject based on the ideXlab platform.
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results of open Arthrolysis for the treatment of stiffness after total knee replacement
Journal of Bone and Joint Surgery-british Volume, 2005Co-Authors: J R M Hutchinson, E N Parish, Mervyn J CrossAbstract:Stiffness is an uncommon but potentially debilitating complication following total knee replacement (TKR). The treatment of this condition remains difficult and controversial. We present the results of 13 patients who underwent open Arthrolysis for stiffness. The mean time between TKR and Arthrolysis was 14 months. The mean follow-up was 7.2 years (2 to 10). The mean range of movement prior to Arthrolysis was 55°. This increased to 91°, six months after Arthrolysis (p < 0.005). The improved range of movement was maintained during the follow-up period. No patient has required revision of their components. We have found Arthrolysis to be a useful and successful approach to post-TKR stiffness.
Bernard F Morrey - One of the best experts on this subject based on the ideXlab platform.
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poor outcomes of isolated tibial insert exchange and Arthrolysis for the management of stiffness following total knee arthroplasty
Journal of Bone and Joint Surgery American Volume, 2001Co-Authors: George C Babis, Robert T Trousdale, Mark W Pagnano, Bernard F MorreyAbstract:Background: Severe stiffness after total knee arthroplasty is a debilitating problem. In patients with securely fixed and appropriately aligned components, Arthrolysis of adhesions and exchange to a thinner tibial polyethylene insert may appear to be a reasonable and logical solution. We reviewed our experience with this procedure to determine its efficacy. Methods: From 1992 through 1998, seven knees with marked stiffness after total knee arthroplasty were treated at our institution with Arthrolysis of adhesions and conversion to a thinner tibial polyethylene insert. Only patients in whom the total knee prosthesis was well aligned, well fixed, and not associated with infection were included. There were five women and two men with a mean age at revision of sixty-one years (range, thirty-eight to seventy-four years). The average time to revision was twelve months, and the mean arc of motion prior to revision was 38.6° (range, 15° to 60°). The duration of follow-up after the insert exchange averaged 4.2 years (range, two to eight years). Results: Mean Knee Society pain and function scores changed from 44 and 36.4 points preoperatively to 39.6 and 46 points at the time of final follow-up. Two knees were rerevised, one because of infection and the other because of aseptic loosening of the components. The five remaining knees were painful and stiff at the time of final follow-up. Four of these five knees were severely painful, and one knee was moderately and occasionally painful. The mean arc of motion of these five knees was 58° (range, 40° to 70°) at the time of final follow-up. Conclusion: Isolated tibial insert exchange, Arthrolysis, and debridement failed to provide a viable solution to the difficult and poorly understood problem of knee stiffness in a group of carefully selected patients following total knee arthroplasty. We therefore have little enthusiasm for the continued use of this strategy.
Wei Wang - One of the best experts on this subject based on the ideXlab platform.
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midterm outcomes after open Arthrolysis for posttraumatic elbow stiffness in children and adolescents
Journal of Pediatric Orthopaedics, 2021Co-Authors: Jihao Ruan, Cunyi Fan, Ziyang Sun, Haomin Cui, Shuai Chen, Wei WangAbstract:BACKGROUND Open Arthrolysis is used for treating elbow stiffness in adults. This study evaluated the midterm outcomes after open Arthrolysis in children and adolescents with posttraumatic elbow stiffness. METHODS Data of 31 children and adolescents with posttraumatic elbow stiffness following open Arthrolysis with or without hinged external fixation from 2010 to 2014 were retrospectively analyzed. Their mean age was 15 (range: 6 to 19) years. At baseline and the follow-up (>4 y), we evaluated the outcomes (range of motion and Mayo Elbow Performance Index) and postoperative complications (pain, ulnar nerve symptoms, infections, and instability) and analyzed the association between outcomes and clinical variables. RESULTS The Mayo Elbow Performance Index improved from 67.9 (range: 35 to 95 points) to 93.7 points (range: 65 to 100 points; P<0.001). The elbow active flexion/extension arc increased significantly from 49 degrees (range: 0 to 120 degrees) to 108 degrees (range: 0 to 120 degrees; P<0.001), with a mean flexion of 123 degrees (range: 70 to 140 degrees; P<0.001) and mean extension of 15 degrees (range: 0 to 85 degrees; P<0.001) postoperatively. The increasing age at surgery was associated with improved elbow motions (P=0.004). Patients with increased preoperative serum alkaline phosphatase level demonstrated decreased arc of motion (P=0.015). Patients with extra-articular fractures had better outcomes than the other patients. At the final follow-up, 8 patients experienced recurrent contracture in the flexion arc with heterotopic ossification. Two patients had postoperative pain, 1 elbow instability, and 1 ulnar neuropathy. CONCLUSIONS Most patients showed satisfactory functional outcomes after Arthrolysis, indicating that open release with or without hinged external fixation is an effective and maintained technique for children and adolescents with posttraumatic elbow stiffness. The age at surgery, preoperative alkaline phosphatase level, and injury type should be considered to achieve good outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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effect of hyperuricemia on functional outcomes and complications in patients with elbow stiffness after open Arthrolysis combined with hinged external fixation a retrospective study
Journal of Shoulder and Elbow Surgery, 2020Co-Authors: Hao Xiong, Ziyang Sun, Shuai Chen, Wei Wang, Wenjun Liu, Shiqiao Peng, Cunyi FanAbstract:BACKGROUND Hyperuricemia is considered a risk factor for increased postoperative complications and adverse functional outcomes in a variety of orthopedic surgeries. The purpose of this retrospective study was to investigate the clinical efficacy of patients with different uric acid levels after elbow Arthrolysis. METHODS The study included 131 patients with post-traumatic elbow stiffness who underwent Arthrolysis between March 2014 and March 2016. All patients were divided into 4 groups based on the preoperative serum level of uric acid (UA). The quartile method was used for grouping patients, including 33 in Q1 (UA <293 μmol/L), 34 in Q2 (293-348 μmol/L), 32 in Q3 (348-441 μmol/L), and 32 in Q4 (441-710 μmol/L). At baseline and each time point of follow-up, functional performance, Mayo Elbow Performance Score, visual analog scale for pain, and complications were evaluated. RESULTS Preoperative data were not significantly different among the 4 groups (Q1, Q2, Q3, and Q4). At the final follow-up, the following data showed significant differences among the 4 groups: extension (P = .031), flexion (P = .008), range of motion (P = .003), Mayo Elbow Performance Score (P = .011), and visual analog scale (P = .032). Interestingly, patients in the Q4 group had the poorest clinical outcomes. However, no significant differences were found among the 4 groups in new onset or exacerbation of nerve symptoms (P = .919), reduced muscle strength (P = .536), instability (P = .567), or infection (P = .374) at the last follow-up. CONCLUSION This study confirms that in patients with post-traumatic elbow stiffness, abnormal serum uric acid metabolism was a risk factor for poor performance and postoperative pain after Arthrolysis. Therefore, detecting the preoperative serum uric acid levels of the patients would be helpful for evaluating the postoperative outcomes.
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what range of motion and functional results can be expected after open Arthrolysis with hinged external fixation for severe posttraumatic elbow stiffness
Clinical Orthopaedics and Related Research, 2019Co-Authors: Ziyang Sun, Haomin Cui, Wei Wang, Jihao Ruan, Cunyi FanAbstract:Background The elbow is more susceptible to loss of motion after trauma than any other joint. Open Arthrolysis often is performed for posttraumatic elbow stiffness if the stiffness does not improve with nonsurgical treatment, but the midterm results of this procedure and factors that may limit recovery have not been widely studied. Questions/purposes We reviewed patients who had undergone open Arthrolysis with hinged external fixator for severe posttraumatic elbow stiffness (ROM ≤ 60°) with a minimum of 5 years followup to (1) analyze ROM gains; (2) assess functional improvement with the Mayo Elbow Performance Index (MEPI) and DASH, quality of life with the SF-36, pain with VAS, and ulnar nerve function with the Amadio rating scale and Dellon classification; and (3) identify complications and risk factors that might hinder mid-term elbow motion recovery after this procedure. Methods Between March 2011 and December 2012, we generally offered patients with elbow stiffness an open Arthrolysis procedure when function did not improve with 6 months of nonoperative therapy, and no contraindications such as immature heterotopic ossification or complete destruction of articular cartilage were present. During that time, 161 patients underwent open Arthrolysis for posttraumatic elbow stiffness at our institution; 49 of them satisfied the study inclusion criteria (adults with elbow ROM ≤ 60° as a result of trauma) and exclusion criteria (stiffness caused by burns or central nervous system injuries, causative trauma associated with nonunion or malunion of the elbow, severe articular damage that would have necessitated joint arthroplasty, or prior elbow release). In general, a combined medial-lateral approach to the elbow was performed to address the soft tissue tethers and any blocks to elbow motion, and a hinged external fixator was applied for 6 weeks to maintain elbow stability and improve the efficacy of postoperative rehabilitation. These patients were evaluated retrospectively at a mean followup period of 69 months (range, 62-83 months), and demographics, disease characteristics, Arthrolysis details, pre- and postoutcome measures as noted, and complications were recorded via an electronic database. Multivariate regression analysis was performed to identify factors associated with ROM recovery. Results At final followup, total ROM increased from a preoperative mean of 27 ± 20° to a postoperative mean of 131 ± 11° (mean difference, 104°; 95% CI, 98°-111°; p 120° (n = 40). After controlling for potential confounding variables such as duration of stiffness and tobacco use, we found that tobacco use was the only independent risk factor examined (odds ratio, 9; 95% CI, 2-47; p = 0.009) associated with recovery of ROM. Conclusions Satisfactory medium-term results were found for open Arthrolysis with hinged external fixation with our protocol in patients who had severe posttraumatic elbow stiffness. Appropriate and sufficient releases of tethered soft tissues and correction of any blocks that affect elbow motion intraoperatively, a dedicated team approach, and an aggressive and systematic postoperative rehabilitation program are the core steps for this procedure. Additionally, the importance of preoperative discontinuation of tobacco use should be emphasized. Level of evidence Level IV, therapeutic study.
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the current state and prospect of open elbow Arthrolysis for post traumatic elbow stiffness
Chinese Journal of Orthopaedic Trauma, 2019Co-Authors: Ziyang Sun, Feiyan Wang, Haomin Cui, Shuai Chen, Hao Xiong, Wei Wang, Cunyi FanAbstract:The elbow is more susceptible to motion loss than other joints after trauma, and elbow stiffness leads to functional impairment in the upper limb and interferes with daily activities. Open Arthrolysis is the most common and classical treatment for post-traumatic elbow stiffness. In this paper, we review the treatment protocols like preoperative clinical evaluation, Arthrolysis strategies and postoperative rehabilitation program for post-traumatic elbow stiffness, discuss relevant issues and assess their prospects. Key words: Trauma; Elbow joints; Stiffness; Preoperative evaluation; Arthrolysis; Heterotopic ossification
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tobacco use predicts poorer clinical outcomes and higher post operative complication rates after open elbow Arthrolysis
Archives of Orthopaedic and Trauma Surgery, 2019Co-Authors: Ziyang Sun, Cunyi Fan, Wei WangAbstract:Tobacco use is a worldwide public health problem, and has been found to be a predisposing factor for adverse functional outcomes and increased postoperative complication rates after various orthopedic operations. The purpose of this study was to determine the potential impact of tobacco use on open Arthrolysis for post-traumatic elbow stiffness. A database search identified 145 patients with open Arthrolysis performed for post-traumatic elbow stiffness; these were divided into three groups: current tobacco users (37), former users (28), and nonusers (80). All surgeries were performed using the same technique by the same doctor. General patient data, functional performance, and complications were documented and analyzed. Demographic data and disease characteristics were comparable at baseline. Postoperatively, significant differences were found among the three groups in terms of range of motion (P < 0.001), Mayo Elbow Performance Score (P = 0.006), visual analog scale score for pain (P = 0.015), Dellon classification for ulnar nerve symptoms (P = 0.013), and total complication rates (P < 0.001). The current tobacco users group had the poorest clinical outcomes and highest complication rates, while no significant differences were found between former users and nonusers. Current tobacco users reported increased risk of poorer clinical outcomes and higher postoperative complication rates after open Arthrolysis. Former users were found to have outcomes similar to those of nonusers. This study underlines the importance of discontinuing tobacco use for patients with post-traumatic elbow stiffness who are considering open Arthrolysis. Level III; Retrospective Cohort Design; Therapeutic Study.
