Open elbow arthrolysis with hinged external fixation for postburn elbow stiffness: a case series with an averaged 4-year follow-up

Patients with severe burns may develop heterotopic ossification (HO), articular cartilage loss, and soft tissue contracture in the elbow, significantly limiting elbow function and diminishing quality of life. Open elbow arthrolysis (OEA) combined with hinged external fixation (HEF) has demonstrated efficacy in managing severe elbow stiffness. However, no recent studies have specifically investigated its application in postburn elbow stiffness. This study evaluates the clinical outcomes of OEA with HEF in patients with postburn elbow stiffness, with an average follow-up period of four years. This study included patients with postburn elbow stiffness treated between May 2018 and December 2021. Eleven participants underwent OEA combined with HEF and were followed up for an average of 50.7 months (range: 37-62 months). Pre- and postoperative data, including elbow and forearm mobility, functional improvements, radiographic results, and complications, were systematically collected and analysed. Substantial improvements were observed in elbow and forearm mobility, with preoperative flexion-extension arc increasing from 14° to 77° and forearm rotation improving from 83° to 105° at the final follow-up (P < 0.001). Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) score and the Mayo Elbow Performance Index (MEPI) significantly improved (P < 0.001). Pain levels notably decreased (P < 0.001). Postoperative complications include transient ulnar nerve symptoms in 2 patients, pain in 3 patients, and 1 HO recurrence. Burn-related elbow stiffness patients treated with OEA and HEF showed encouraging clinical results, marked by notable enhancements in elbow movement and functionality. The results proved the technique effective for elbow stiffness after burn injury. Level IV, Case Series, Treatment Study.