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
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.