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Prevention of nerve injury during arthroscopic capsulectomy of the elbow utilizing a safety-driven strategy.
J Bone Joint Surg Am. 2013 Aug 7;95(15):1373-81
Authors: Blonna D, Wolf JM, Fitzsimmons JS, O'Driscoll SW
Abstract
BACKGROUND: A major factor limiting the use of elbow arthroscopy for contracture release is concern regarding nerve injury. The purpose of this report is to document the risk of nerve injury in a large series of arthroscopic contracture releases utilizing a safety-driven strategy.
METHODS: A series of 502 arthroscopic elbow contracture releases (including 388 osteocapsular arthroplasties) performed in 464 patients by one surgeon was reviewed retrospectively. The safety-driven step-wise strategy had been carried out in a standardized sequence: (1) Get In and Establish a View, (2) Create a Space in Which to Work, (3) Bone Removal, and (4) Capsulectomy. Neurologic complications were assessed and were followed until resolution.
RESULTS: No patient had a permanent nerve injury. Twenty-four patients (5%) had a transient nerve injury, associated with prolonged tourniquet time, cutaneous dysesthesia attributed to open incisions, simultaneous ulnar nerve transposition, or retractor use. All nerve deficits resolved after one day to twenty-four months, with one patient lost to follow-up.
CONCLUSIONS: Utilizing the technique described, arthroscopic contracture release and debridement of the elbow was performed with a low risk of nerve injury.
LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
PMID: 23925741 [PubMed - in process]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23925741?dopt=Abstract
