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Hinged Elbow External Fixation for Severe Elbow Contracture
David Ring, MD1; Robert N. Hotchkiss, MD2; Daniel Guss, BA1; Jesse B. Jupiter, MD1
1 Massachusetts General Hospital, ACC 525, 15 Parkman Street, Boston, MA 02114. E-mail address for D. Ring: dring@partners.org
2 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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Investigation performed at Massachusetts General Hospital, Boston, Massachusetts, and The Hospital for Special Surgery, New York, NY

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1293-1296. doi: 10.2106/JBJS.D.02462
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Background: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open release of a severe elbow contracture.

Methods: Forty-two patients were evaluated at an average of thirty-nine months after operative release of a severe posttraumatic elbow contracture (defined as =40° of motion). Twenty-three patients had been treated, during the early part of the study, with a hinged external fixator that incorporated a worm gear to apply static progressive stretch postoperatively. These patients were compared with nineteen patients who had been treated without hinged external fixation during the later part of the study, when the hinge was used less frequently. The operative techniques did not otherwise change during the study period. Demographic and injury characteristics as well as associated problems were comparable between the two groups.

Results: The average gain in the range of motion after the index procedure was 89° in the patients treated with a hinge and 78° in those treated without a hinge, an insignificant difference with the numbers available (p = 0.175). Complications associated with use of the hinge included five pin-track infections, one case of pin-track osteomyelitis, one ulnar fracture through a pin site, two broken Schanz screws, and two cases of irritation of the ulnar nerve.

Conclusions: Open release of a severe elbow contracture results in a substantial gain in motion, with or without hinged elbow fixation. The slightly greater improvement in motion provided by the hinge does not justify the associated increase in risk, expense, and complications.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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