Elbow arthrolysis for post-traumatic stiffness: Predictive factors of outcome

Introduction: The purpose of this study was to evaluate the outcomes of open elbow arthrolysis in post-traumatic elbow stiffness and to identify prognostic factors influencing functional results and range of motion (ROM).
Patients and Methods: Between 2016 and 2021, 21 elbow arthrolysis procedures were performed at our institution. Sixteen patients were available for retrospective evaluation, while five were lost to follow-up. The mean age was 42.3 years (range, 14–70). Etiologies included elbow dislocation, radial head fractures, olecranon fractures, distal humeral fractures, and post-traumatic soft-tissue contractures. According to Morrey’s classification, stiffness was intrinsic in 10 cases and extrinsic in 6 cases.
Surgical approaches were posterior (n = 2), lateral (n = 7), and combined posterior–lateral (n = 7). All patients underwent open arthrolysis followed by immediate postoperative mobilization and standardized rehabilitation. ROM was measured preoperatively, immediately postoperatively, and at final follow-up. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) score and Visual Analog Scale (VAS). Mean follow-up was 57 months (range, 13–71).
Results: The mean flexion-extension arc improved from 47° preoperatively to 114° immediately postoperatively. At final follow-up, a mild loss of motion was observed, with a mean arc of 87°, corresponding to a decrease of approximately 5°–10° compared with the immediate postoperative result.
The mean functional gain in flexion-extension arc was approximately 40°. Most patients achieved a functional pronation–supination arc greater than 100°.
At final follow-up, the mean DASH score was 53.4 and the mean VAS pain score was 5. Eight patients were highly satisfied, five were satisfied, and three were dissatisfied.
Final ROM was significantly correlated with preoperative stiffness severity (p = 0.001) and immediate postoperative mobility. Patients treated within one year of injury achieved significantly better outcomes (p < 0.05). No significant association was found between outcomes and age, sex, etiology, or surgical approach.
Conclusion: Open elbow arthrolysis is an effective procedure for post-traumatic elbow stiffness. Final ROM is mainly determined by preoperative stiffness severity and time to surgery. A slight postoperative loss of motion (5°–10°) may occur, but functional improvement remains significant and durable.