OpenCapsularReleaseoftheElbow肘关节囊释放开.pptx

Classification
Extra-articular or extrinsic
capsule, ligament, muscle or combination
heterotopic ossification of the soft tissue
Intra-articular or intrinsic
articular cartilage abnormality
Conservative Treatment of Elbow Stiffness
Flexion and/or extension splints
best if begun early
dynamic splinting if tolerated
Manipulation under anesthesia
Surgical Release
Arthroscopic
Open
Advantages of an Open Approach
Safer and easier for most surgeons
More predictable result
Better anterior visualization of a severely scarred anterior compartment
Easier conversion to conjunctive procedures
Disadvantages of an Open Approach
Larger incision
More difficult inspection of the entire joint
Indications for Open Release (Anterior and/or Posterior)
Symptomatic extrinsic extension deficit (flexion contracture)
20-30 degrees “gray zone”
>30 degrees
Symptomatic extrinsic flexion deficit (extension contracture)
Flexion < 110 degrees
Open Conjunctive Procedures
Biceps tendon lengthening
Brachialis myotomy
Collateral ligament release
Radial head resection
Open Release Surgical Technique
Pre-operative and intra-operative assessment of neurovascular status and range of motion
Patient in supine position
High arm tourniquet
Technique
Exsanguinate the arm and elevate the tourniquet
Prep and drape the arm in a sterile fashion
Incisions
Posterior
long and requires large skin flaps
Medial
requires mobilization of the ulnar nerve
Anterior
greater risk to the neurovascular structures
Lateral
Preferred for safety and versatility