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The Olecranon Osteotomy Facilitated Elbow Release (OFER): A Simplified, Safe and Effective Approach for the Treatment of Elbow Contracture
Scott G. Edwards, MD1; David A Rhodes, MD2; Thomas W Jordan, MD3; Debra Sietsema, PhD, RN1
1The CORE Institute, Phoenix, AZ, 2University of Arizona COM-Phoenix, Phoenix, AZ, 3Georgetown University Hospital, Washington, DC

Background: Elbow contractures cause significant functional limitations for affected patients and their treatment is challenging. There appears to be need for a new procedure to treat elbow contractures that is technically less demanding and easier for the patient to rehabilitate. This is the first clinical report of a novel technique that releases post-traumatic elbow contractures through an olecranon osteotomy. Methods 39 consecutive patients with refractory post-traumatic elbow contractures underwent an olecranon osteotomy-facilitated elbow release (OFER) procedure with a minimum follow up of 24 months. 4 patients were excluded due to inadequate follow up. Preoperative data and postoperative data collected included age, gender, cause for contracture, previous surgeries, active elbow flexion and extension, Disabilities for Arm, Shoulder, and Hand (DASH) scores, analog pain scores, and plain radiographs. Intraoperative tourniquet time and complications were also noted. Results Average age of patients undergoing the OFER procedure was 39.5 years with a mean follow up of 34.2 months (range 24 to 72 months). Pre-operative mean flexion deformity was 84 and mean extension was 51. Post-operatively, these motions were corrected to 126 (p<0.001) and 16 (p<0.001) respectively. The mean flexion/extension arc improved from 35 to 110 (p<0.001). Subjective pain scale also showed improvement from a pre-operative mean of 6.3/10 to a post-operative 1.4/10 (p<0.001). DASH scores showed improvement from 57.5 preoperatively to 10.9 postoperatively (p<0.001). Maximal improvement occurred at a mean follow-up time of 8.7 weeks. One ulnar neuropathy occurred post-operatively which spontaneously resolved. There were no other complications. Intraoperative tourniquet time averaged 27 minutes. The average time to osteotomy radiographic union was 6.6 weeks. Conclusions The OFER is a simple, safe and effective means of treating elbow contractures. In this study, patients achieved significant gains in functional status that appears substantially better than most reported for other techniques. Further, the authors offer this procedure as a faster and simpler alternative to traditional open or arthroscopic techniques.


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