Two-stage surgical treatment of a patient with flexion-extension contracture of the elbow joint using hydraulic mobilization

Backgorund. Numerous surgical techniques have been proposed for the treatment of patients with persistent elbow contractures that cause significant functional impairment. However, the treatment results are not always satisfactory for surgeons and patients due to the invasive nature of the procedure and the risk of contracture recurrence. Aim. To demonstrate the feasibility of using hydraulic mobilization for the management of the soft tissue component of contracture to improve elbow function.

Methods. During the first stage of surgical treatment, hydraulic mobilization of the elbow joint and collateral ligaments was performed to increase the angle of extension. Saline solution was used to dilate the joint cavity, stretch the capsule, and release any scarring from the ligaments. Tunneling of the proximal metadiaphysis of the ulna and distal metadiaphysis of the humerus was also performed to improve blood flow to the bone and reduce intraosseous pressure. At the second stage of treatment (6 months after the first stage of surgery), arthrotomy of the left elbow joint, osteotomy of the malunited fragment of the humeral capitellum, its resection, and plaster immobilization of the left upper limb were performed.

Results. After the first stage of treatment, the elbow extension angle was increased to full extension. After the second stage, elbow flexion function improved. The patient’s quality of life improved, and they are now able to use their arm fully. No significant pain was reported.

Conclusions. In this case, the presented treatment strategy is justified and optimal, as it adheres to the principles of gentle tissue handling during surgery, early initiation of active motion, and avoidance of passive redressing manipulations that cause pain and microtrauma to the elbow joint and accelerate mesenchymal tissue maturation. Hydraulic mobilization requires no additional surgical approaches or special equipment, causes virtually no trauma to surrounding tissues, reduces surgical time, and eliminates the risks of open surgical techniques.

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