Copyright

1990

by The Journal

ofBone

and

Joint

Surgery,

incorporated

The Lateral Approach

for Operative
Release
of Post-Traumatic
Contracture
of the Elbow*
BY

JEFFREY

B.

HUSBAND,

M.D.,

the Department

From

F.R.C.S.(C)t,

AND

of Orthopaedic

Surgery,

ABSTRACT:
A lateral approach
was used to release
a post-traumatic
contracture
of the elbow in seven patients,
and the results
were evaluated
an average
of
thirty-eight
months
postoperatively.
Extension
improved from an average flexion contracture
of4S degrees
preoperatively
to one of 12 degrees
postoperatively,
and
the average
point of maximum
flexion increased
from
116 degrees
preoperatively
to 129 degrees
postoperatively.
The average
arc of motion increased
46 degrees.
All patients
began using a continuous-passive-motion
device immediately
after the operation.
There were no
problems
with
wound-healing
or formation
of heterotopic bone.

HILL

HASTINGS,

II,

Indiana

University

Medical

us (H.

and a static
fail

or dynamic

to restore

splint.

adequate

When

motion,

non-operative
operative

measures

release

may

be

indicated.
In the past, flexion contractures
of the elbow have
been released through an anterior approach
with lengthening
of the biceps tendon,
release of the brachialis
muscle,
and
anterior capsulotomy38#{176}. To correct the less common
cxtension contracture
of the elbow, a posterior
approach
has
been used3#{176}.
We found few reports38#{176}on operative
treatment of
contractures
of the elbow,
and these included
relatively
small

numbers

of patients,

mixed

high rates of complications.

In this report, we describe
for the release of post-traumatic

causes

of contracture,

and

the use of a lateral approach

contracture
of the elbow.

1984

and

1988,

Indiana

Center

INDIANA

Indianapolis

the

range

of motion

of the

elbow

a program

of postoperative

therapy.

The

severity

of

the contracture,
the number
of previous
operative
procedures, the age of the patient,
and the presence
or absence
of heterotopic
bone did not affect the selection
of patients
for the operation.
All of the contractures
were the result of trauma to the
elbow. Several patients had had associated
injuries, but none
had an injury to the head or spinal cord or a burn that might
have contributed
to the contracture.
There were six men and one woman,
and the average
age was thirty-two
years (range,
thirteen
to sixty-two
yeas)
(Table I). The mechanism
of injury was a fracture
of the
distal part of the humerus
in three patients,
a fracture-dislocation

in three

patients,

and

a fracture

of the radial

head

in one patient.
The initial
treatment
included
closed
management
alone with traction,
a cast, or a splint in three patients;
reduction

and

percutaneous

pinning

in one

patient;

open reduction
and internal
fixation
in two patients;
and
excision of the radial head in one patient. One patient (Case
2) had

at the

School,

H. , II) because

closed

Materials
Between

INDIANAPOLIS,

was limited.
The operation
was considered
to be indicated
only if
motion of the elbow was so restricted
that the patient thought
that function was seriously
limited, function did not improve
enough
despite
supervised
physical
therapy
that included
dynamic
extension
or flexion splinting
for at least twelve
weeks, there was a flexion contracture
of at least 35 degrees
or limitation
of active additional
flexion to less than 100
degrees,
soft-tissue
coverage
of the operative
site was adequate, and the interval from injury to operation
was a mmimum of five months.
The only contraindication
to the
procedure
was apparent
inability
of the patient to comply
with

Contracture
of the elbow
may result from a variety
of
causes,
including
trauma,
heterotopic
ossification,
a burn,
spasticity,
and postoperative
scarring3470.
Many contractures can be managed
successfully
with physical
therapy

M.D4,

for

sustained

an open

fracture-dislocation

with

incom-

Surgery
and Rehabilitation
of the Hand and Upper
Extremity, operative
release
of a post-traumatic
contracture
of the
elbow was done in seven patients.
All of these patients
had

plete amputation,
and treatment
had included
grafting with
the saphenous
vein to reconstruct
the brachial
artery.
In
another patient (Case 6), treatment
at another institution
had
included
open reduction
and internal
fixation,
prolonged

been

immobilization

initially

treated

elsewhere

No benefits in any form

a commercial

party

related

have

directly

and were

referred

to one

of

been received or will be received

from
or indirectly to the subject ofthis article.

No funds were received

820

in support
of this study.
of Orthopaedic
Surgery,
Health
Sciences
Street,
Winnipeg,
Manitoba
R3A lR9,

t Section
Sherbrook

Centre,
Canada.

GF

311-

Indiana Center for Surgery and Rehabilitation

ofthe Hand and Upper
Extremity,
P.O. Box 80434, 8501 Harcourt
Road, Indianapolis,
Indiana
46280-0434.
Please
address
requests
for reprints
to Dr. Hastings.

VOL.

72-A,

NO.

9, OCTOBER

1990

in a cast,

and

electrical

stimulation.

In one patient,
preoperative
radiographs
of the elbow
showed
a small amount
of heterotopic
bone that did not
appear to be substantial
enough to cause a contracture.
In
another
patient,
radiographs
showed
traumatic
arthritis
of
the capitellum.
in whom
epicondyle

A retained

fragment

was

seen

in one patient

the radial
head
had been resected,
the medial
was ununited
in another
patient,
and an ununited
1353

1354

J.

B.

HUSBAND

AND

HILL

HASTINGS,

II
TABLE

Preop.

Case

Involved

Domi-

Age

Elbow

nance

Injury

F, 30

Supracondylar

Sex,

Mechanism

of

from Injury
to Operation
(Mos.)

(Yrs.)

of the
2

M,

M,

13

16

M, 24

fract.

Closed

reduct.

percutan.

humerus

Open fract.-dislocat.
of the med. epicondyle,
rupture
of the brachial
artery

ORIF,

Fract.-dislocat.
of the
olecranon
and
med. epicondyle

Closed

Supracondylar

Olecranon

fract.

of the humerus,
fract.
of the med.
epicondyle
5

M,

42

Fracture
head

of the

M, 62

Open T-type condylar

fract. of the

and

Healed

pin

vein

cast,

traction,

; cast,

Malunion

Excision
head;
ORIF

of the radial
cast, 6 wks.
x 2

M,

ORIF

35

open

reduction

Retained
radial

the

Healed

of the

maxiof 35

(average,
1 16 degrees).
The duration
of follow-up
ranged
from twenty-three
to sixty months, with an average of thirtyeight months.
We examined
all patients
in our offices,
all patients
responded
to a written
questionnaire.

and

: cast,

anesthesia
to facilitate

with

Marcaine

(bu-

postoperative

mobi-

lization.

of the humerus,
and ends near
dissection
condylar
the level

is an extension

proximally

along

proximally

of the Kocher

the lateral

proceeds
distally
the subcutaneous
is carried

Lat.

T-condylar

36

Lat.

Lat.

; traumat.

Fragment
coronoid

of the
process

approach2.

supracondylar

ridge

to the lateral epicondyle,

border
of the ulna.
Deep
down

to the

ridge,
with subperiosteal
stripping
of the anterior
aspect
of the capsule.

lateral

supra-

anteriorly,
Distally,

to
the

After

freeing

the triceps

tendon

from

adhesions,

medially,

or laterally

blocks

complete

extension

3).

Next,
to improve
flexion,
tenolysis
of the triceps
is
done,
if it has not been done already,
and posterior
capsulectomy
is performed.
If the elbow
cannot
be flexed to at
least 135 degrees
at this point, a source of anterior
impingement is sought.
The capsule
and any scar tissue are cleared
from the coronoid
fossa of the anterior
aspect
of the humerus.
When an enlarged
coronoid
process
of the ulna abuts
the anterior
aspect
of the humerus,
the pat of the coronoid
process
that is proximal
to the insertion
of the brachialis
tendon
with

is excised.
The lateral
sleeve
the use of drill-holes

stability
a suction

tractors
are placed deep to the extensor
capi
brachioradialis,
and brachialis
to provide

plied.
A temporary
tension.

longus,
of the

is

the surgeon
retracts
the triceps posteriorly
to expose
the
olecranon
fossa. Additional
extension
may be gained if the
olecranon
fossa
is cleared
of all soft tissue.
Part of the
olecranon
is removed
if any enlargement
of its margins

interval
between
the extensor
carpi ulnaris
and the anconeus
is opened
to expose
the elbow joint laterally
(Fig.
1 ). Reradialis
exposure

capsulectomy

side of the elbow

elbow
is brought
into maximum
extension.
If cxis still incomplete,
dissection
is carried
out posteto look for soft tissue
or bone that is blocking
full

extension.

(Fig.

Technique

incision

The

posteriorly,

Methods

The

and

fixation.

degrees
to one of 65 degrees
(average,
45 degrees),
and the
point of maximum
flexion
ranged
from 100 to 135 degrees

It begins

Lat.

of the

tension
riorly

block

arthritis
Closed
reduct.
1 wk.

months.
Preoperatively,
the
from a flexion
contracture

hydrochloride)

Lat.

med.

an average
of fourteen
mum
extension
ranged

We use axillary

14

med.

anterior
part of the capsule.
An anterior
done from the lateral side to the medial
(Fig. 2).

pivacaine

Lat.

fragment
of the coronoid
process
was found in a third patient.
The interval from the injury to the operative
release of
the contracture
ranged from seven to thirty-six
months, with

Operative

11

to

fract.

fragment
head

fract.

Fract. -dislocat.
of the
coronoid
process

and internal

of

of

supracondylar

4 wks.

and

Lat.

med.

non-union
epicondyle

radial

of

14

Healed
fract.
of the
med. epicondyle;
small lat. heterotopic
ossification

humerus
7

supracondylar

Traumat.
arthritis
capitellum
sec.
osteonecrosis

wks.

wks.

Locations
Incisions

fract.

graft

reduct.:

ON

Interval

Radiographic
Features

Initial
Treatment*

DATA

of soft tissue
is carefully
repaired
in the humerus,
to restore
lateral

of the elbow
(Fig. 4). The wound
catheter,
and a light compressive
splint

ThE

is applied

JOURNAL

with

OF BONE

is drained
dressing
the

AND

elbow

JOINT

with
is apin cx-

SURGERY

THE

LATERAL

APPROACH

FOR

OPERATIVE

RELEASE

OF POST-TRAUMATIC

CONTRACTURE

OF

THE

1355

ELBOW

I
THE PATIENTS

Sites of
Osseous
Procedures

Active
Extension
to a Flexion
Contracture
of (Degrees):

Other
Procedures

Decompression
median
nerve

Additional
Active
Flexion
to (Degrees):

Preop.

Postop.

40

45

35

of the

Change

Preop.

40

Postop.

Compli-

Duration

cations

Follow-up
(Mos.)

Change

120

140

+ 20

+45

105

120

+ 15

43

10

+25

135

135

39

45

10

+ 35

120

135

+ 15

60

65

10

+55

110

125

+ 15

25

35

30

100

115

50

25

125

135

+ 10

Transient
ulnar-nerve

of

23

paresth.
Olecranon,
capitellum,
head

radial

Olecranon

Olecranon,
process

coronoid

Excision
of the
epicondyle,
decompression
ulnar nerve

Olecranon,
lat.

Excision

condyle

med.
of the

of a fragment

of the radial

head

Coronoid
process

Olecranon

Excision

of a coronoid

+ 5

+ 25

15

41

34

fragment

Postoperative

pital

Therapy

Immediately

after

room,

the

while

the patient
Marcaine

moves
block

to a regular

hos-

the shoulder
adducted
the lateral soft-tissue

so that varus stress is not applied to

repair. Visits for supervised
physical

minimizes

dis-

therapy

or three

still

comfort,
a physical
therapist
places
the elbow
in a continuous-passive-motion
device
(Richards,
Memphis,
Tennessee). It is essential
that the device
establish
as complete
an
arc of motion
of the elbow
as possible
while the axillary
block remains
in effect.
Passive
motion
with the machine
continues
without
interruption
until the first change
of dressing, the morning
after the operation,
when a lighter dressing
is applied.
Continuous
passive
motion
is used for at least
twelve
hours
a day for the remainder
of the patients
hos-

pitalization
In addition,

(the average stay in the hospital was six days).

active and passive
motion exercises
are done

four times a day for ten minutes.

In most instances,
continuous
passive
motion
is continued
while
the patient
is

are made

two

performed

At six weeks,

through

a lateral

incision.

The

biceps

tendon

was

to increase
extension,
and the coronoid
process
was partially
excised
in two patients,
to increase
flexion.
The capitellum

was debrided
in the patient who had traumatic
arthritis.
An additional,
medial incision was used in two patients:
for decompression
of the ulnar nerve in one and for decompression

of the median

nerve

in another.

Results
The

patient

is discharged

is comfortable
wound
is dry,

that obtained

from

the hospital

with oral administration

and the range
of motion

when

he or

of analgesics,
approximates

elbow

at the end of the operation.

is placed

in a static

tween
exercises
that obtained
at
used during
the
this was needed

perform
72-A,

active

Orthoplast

extension

splint

NO. 9, OCTOBER

1990

range-of-motion

exercises

follow-up

with

examination,

tional

arc (Fig.
All patients

5).
responded

in writing

to

120 degrees);
had regained

posta func-

to a questionnaire

that

is part of the evaluation

of the elbow
that
by Morrey
et al. at the Mayo Clinic
(Table
diminished,
with the scores
improving
from

operatively
score,

to 4.9 points

5 points).

The

postoperatively
patients

all patients

motion
of the elbow (average
II). Preoperatively,
no patient

had a functional
arc of motion
(30
operatively,
six of the seven patients

be-

and at night.
When
extension
is less than
operation,
a dynamic
extension
splint
is
day and a static Orthoplast
splint,
at night;
for five patients.
Patients
are instructed
to

and passive

At the most recent

had an improved
arc of active
increase,
46 degrees)
(Table

After discharge,
the patient
performs
active and passive
range-of-motion
exercises
for ten minutes
each hour.
The

VOL.

a week.

lengthened
in only one patient, to improve
the flexion contracture.
The olecranon
was partially excised in five elbows,

asleep.
she
the

times

the splint is no longer worn during the day. An extension

splint is worn at night for an additional
six weeks.
In all patients,
both anterior and posterior
release were

assessed

was developed
HI). Pain was
2.8 points pre-

(maximum
function

possible
by grading

1356

J.

B.

HUSBAND

AND

HILL

HASTINGS,

TABLE

their ability to perform twelve common

tasks: using the back
pocket,
rising from a chair, perineal
care, washing
the opposite axilla, eating with a utensil, combing
the hair, carrying 4.5
pulling,

to 6.8 kilograms
throwing,
doing

usual sports
proved
from

activities.
5. 1 points

operatively

(two to fifteen pounds),

dressing,
usual work,
and participating
in
The

average

score

preoperatively
possible
score,

(maximum

for function

im-

to 10.4 points
12 points).

post-

II

RESULTS:

AVERAGE

AND

TOTAL

II

FLEXION,
ARC

FLEXION

OF MOTION

(IN

Preop.
45

12

+ 33

129

+ 13

motion

71

117

+ 46

fiexion

of

the

of

Change

116

deformity

Further
arc

Postop.

to:

Flexion

Total

DEFORMITY,
DEGREES)

elbow

Complications
There

was

one

complication,

transient
paresthesia
spontaneously.
Even
used

immediately

tolerated

it,

dehiscence

after

and
of

there

the

Postoperatively,

in a patient

who

had

of the ulnar nerve,

which resolved
though continuous
passive motion was
the
were

wound,

there

operation,
no

all

problems

delayed

of the
with

healing,

was no formation

or

patients
regard

to

infection.

of heterotopic

bone.

of motion
from 30 degrees
short of full extension
to 120
degrees
of flexion
(90 degrees
of motion)
is considered
essential
for most activities
of daily
We do not believe
that the elbow
if there
is a well
contractures,
with
forceful
manipulation
nipulation
ditional

Discussion
Function

extent,
motion

of the

on a persons
of the elbow.

upper

ability
Loss

extremity

depends,

to position
of motion

seriously
interfere
with daily
activities,
but
metric
analysis
has suggested
that full motion

for most

activities.

Opinions

differ

but,

generally,

1 : A lateral
2: Anterior

incision
retraction

is made
of the

3: The triceps
tendon
is retracted
4: Repair
of the soft-tissue
sleeve

post-traumatic

contractures

posteriorly,
to bone

be

managed

alone.
motion

successfully

with

FIG.

capsulectomy

is performed.

Osteotomy

partic-

measures

and passive
range-ofsplint.
However,
we

FIG.
a posterior
stability.

ad-

are not associated

ossification,
can

non-operative

These
measures
include
active
exercises
and use of a dynamic

3
and
restores

of the elbow,

ularly those that are of short duration

and
with blocking
bone or bridging
heterotopic

over the left elbow,

with deep dissection
between
the anconeus
and the common
common
extensors
and the brachialis
provides
exposure
for anterior
capsulotomy.

FIG.

Fig.
Fig.

an arc

to the formation
of hematoma,
heterotopic
ossification.

FIG.

Fig.
Fig.

electrogoniois not needed

established
contracture.
Long-standing
mature
scar tissue,
do not respond
to
in the operating
room,
and such ma-

predisposes
scarring,
and

Some

to a large

the hand through

of the elbow can

living6.
should be manipulated

extensor

muscles.

of the

THE JOURNAL

olecranon

may

OF BONE

increase

AND

JOINT

extension.

SURGERY

THE

LATERAL

APPROACH

FOR

OPERATIVE

RELEASE

OF

POST-TRAUMATIC

elbow

in the

English-language

literature.

Five

SCALE

in four

of them.

Wilsons

cluded one patient in whom a post-traumatic

tracture
was released
through
a posterior

also

extension
incision

In four

flexion

of the patients,

including

one

was due to a burn,

a flexion
released
through
an anterior
approach.

ion contracture)
remaining

improved

two

an average

patients,

an

in whom

the contrac-

contracture
Extension

had been
(the flex-

of 37 degrees.

extension

In the

contracture

was

re-

Lateral
lateral

leased through a posterior

approach.
One of these two contractures
was due to a fracture-dislocation
and the other, to
arthrogryposis.
Flexion improved
an average of 70 degrees,

Points

severe

(much

pain);

medication

(constant

pain);

of

marked

activity

disability

dissection
incision.

and release
The flexion

was carried
contracture

erage of 25 degrees and the point

average of 8 degrees.

out through
improved

of maximum

Pre-op

Post-op
150-

140

140

135135

130

135

135
125

120

120

120

110

ioo

90
80

I-.

70

60

40

C.)

30

50

125

120

115
110

0)

:.

1o

100 150

65

45

40

45
-

36

3
30

20
<
FuH

25

10

10

10

Extension

_0

+5

10

10

C
0

+10

U,

C
0)

a
a,

FIG.
A comparison

VOL.

72-A,

NO.

9, OCTOBER

1990

PATIENTS

0.

I
of

the

preoperative

and

PAIN

but no active flexion was restored

to the patient who had
arthrogryposis.
Willner described
the use of combined
medial and lateral approaches
for the correction
of a contracture
in ten
patients,
eight of whom had sustained
shrapnel
injuries
to
the elbow.
Most of the release
was done through
a long
medial incision,
with osteotomy
of the medial epicondyle.

extension.

and Niebauer
reported
on six patients in whom
of the elbow had been released
operatively.

ture

RATED

with occasional
some medication

Complete

and

both

Glynn
a contracture

POSTOPERATIVELY

Moderate,
activity;

limitation

increase

AND

Severe

One patient
had a posterior
incision
as anterior
and medial
incisions,
to

PATIENTS

in-

posterior
capsulotomy.
and release,
as well

Ill

THE

Slight,
with continuous
activity;
no medication

frequent

1357

ELBOW

None

Moderately

conwith

THE

of Pain

Description

patients

study

WITH WHICH

PREOPERATIVELY

had release of a flexion contracture

through an anterior approach, with anterior capsulectomy
and step-cut lengthening
of the biceps tendon.
Extension
(the flexion contracture)
improved
an average
of 42 degrees.
All five patients
were
less than fourteen
yeas
old, and nerve palsy developed
postoperatively

OF

TABLE

found that when such therapy is used more than six months
after the injury, it does not improve
the range of motion.
An operation
is then the only way to release a contracture.
To our knowledge,
Wilson,
in 1944, was the first to
report an operative
release of post-traumatic
contracture
of
the

CONTRACTURE

postoperative

arcs

of

motion

of

the

elbow.

a short
an av-

flexion,

an

1358

J.

Recently,
patients

B.

HUSBAND

AND

Urbaniak

Ct al. reported
the cases of fifteen
a post-traumatic
flexion
contracture
had

in whom

been released
through
an anterior
approach.
Anterior
capsulotomy
was done without
lengthening
of the biceps tendon. Postoperatively,
the elbows were immobilized
for two
weeks.
Over-all,
the flexion contracture
improved
from 48
degrees
to 19 degrees,
with the least improvement
in four
patients
who had traumatic
arthritis.
The average
arc of
flexion changed
little (a decrease
of 3 degrees),
but five
patients
palsy

lost 20 degrees
developed

of flexion

in three

In all of our patients,

post-traumatic,
and some
evident.

The

arthritis

or more.

A transient

nerve

patients.

the contracture
of the elbow
degree of traumatic
arthritis

usually

was

manifested

by mild

was
was
en-

HILL

HASTINGS,

II

been

fixed directly
to the humeral
diaphysis.
Release
of post-traumatic
flexion
contractures
an anterior
approach
can increase
extension
markedly.

through
There

are several disadvantages:

(1) the need for an additional
posterior
incision for complete
release;
(2) additional
scarring

of

the

anterior

structures,

which

may

predispose

to

recurrence
of the contracture;
(3) the potential
loss of important flexion; (4) the serious incidence
of postoperative
nerve palsy; and (5) a delay in healing
of the wound,
or
even dehiscence
of the wound, due to excessive
tension of
the skin about the wound caused by the use of immediate
continuous
passive motion.
The lateral approach
and the technique
described
in
this

paper

have

several

advantages

over

the

anterior

ap-

largement
of the posterior
part of the olecranon
and anterior
part of the coronoid
process;
these changes
were readily
apparent
on plain radiographs.
Radiographs
showed
more
severe arthritis
of the capitellum
in one patient and of the

proach.
Anterior
and posterior
exposure
is possible
through
one lateral incision,
through
which a complete
capsulectomy
and brachialis
fasciotomy
can be done. Additional
extension

radial

and by excision

head

in another,

diocapitellar
adversely.

joint
One

did

patient

but

arthritic

involvement

not

appear

to influence

(Case

6) had

mild

of the ra-

the results

arthritic

changes

at the ulnotrochlear
joint, secondary
to a previous
T-type
condylar
fracture of the humerus.
In this patient, the medial
and lateral portions
of the trochlear
facet of the ulna were
found to be fairly well aligned at operation,
although
there
were early degenerative
changes
in the joint. This did not
appear to affect motion adversely
at the time of the most
recent follow-up
examination,
forty-one
months postoperatively. Restoration
of flexion remained
limited because of
loss

of the coronoid

fossa,

where

the humeral

condyles

had

can be gained

by clearing the olecranon

fossa of soft tissue
of part of the olecranon
if it impinges
when
the elbow is in maximum
extension.
Posteriorly,
tenolysis
of the triceps and capsulectomy
can increase
flexion.
If an
enlarged

coronoid

process

limits

flexion

by

humerus,
bone of the coronoid
process
can
Repair of the lateral soft-tissue
sleeve to bone
bility

of the elbow

and

allows

safe,

early

abutting

the

be excised.
restores
sta-

motion.

The

lo-

cation of the incision

in the neutral
axis of flexion-extension
makes
it less likely that tension
from the use of immediate
continuous
passive
motion
will cause problems
with woundhealing.
The risks of anterior
scarring
and recurrent
contracture
are thus diminished.

References
1.

CARSTAM,

2.

CRENSHAW,

Mosby,
3.

4.

GLYNN,
HOFFER,

Operative
Treatment
of Fractures
of the Head and Neck of the
A. H.: Surgical
Approaches.
In Campbells
Operative
Orthopaedics,

NILS:

1987.
J. J. , and NIEBAUER,
J. J.: Flexion
and Extension
Contracture
of the Elbow.
M. M.; BRODY, GARRY; and FERLIC, Fp.ED: Excision
of Heterotopic
Ossification

18: 667-670,
5.
6.
7.
8.

9.
10.

Radius.
edited

Acta Orthop.
Scandinavica,
by A. H. Crenshaw.
Ed.
Surgical
about

19: 502-526,
1950.
7, pp. 92-93.
St. Louis,

C. V.

Management.
Clin. Orthop. , 117: 289-291,
1976.
Elbows
in Patients
with Thermal
Injury. J. Trauma,

1978.

B. F.; AN, K. N.; and CHAO, E. Y. S.: Functional

Evaluation
of the Elbow.
In The Elbow
and Its Disorders,
pp. 88-89.
Edited by B.
F. Morrey.
Philadelphia,
W. B. Saunders,
1985.
MORJEY,
B. F.; Asc.aw,
L. J.; AN, K. N.; and CHAO, E. Y.: A Biomechanical
Study of Normal
Functional
Elbow
Motion.
J. Bone and Joint
Surg. , 63-A:
872-877,
July 1981.
THOMPSON,
H. C. , III, and GARCIA, ALEXANDER:
Myositis
Ossificans:
Aftermath
of Elbow
Injuries.
Clin. Orthop.,
50: 129-134,
1967.
URBANIAK,
J. R. ; HANSEN,
P. E. ; BEISSINGER,
S. F. ; and AITKEN,
M. S. : Correction
of Post-Traumatic
Flexion
Contracture
of the Elbow
by
Anterior Capsulotomy.
J. Bone and Joint Surg. , 67-A:
1160-1164,
Oct.
1985.
WILLNER,
PHILIP:
Anterior
Capsulectomy
for Contractures
of the Elbow.
J. Internat.
Coll. Surg. , 11: 359-362,
1948.
WILSON,
P. D.: Capsulectomy
for the Relief
of Flexion
Contractures
of the Elbow
following
Fracture.
J. Bone and Joint Surg. , 26: 71-86,
Jan.
MORREY,

1944.

ThE

JOURNAL

OF BONE

AND

JOINT

SURGERY