The elbow joint is a highly restricted hinge joint. Among all the joints, the elbow is the most prone to post-traumatic stiffness. It is reported that the incidence of elbow stiffness after trauma is about 16%-40%, and the risk of elbow joint stiffness after trauma ranks first among all joint traumas. The severity of limitation of flexion and extension is classified according to Morrey's elbow stiffness classification, including extremely severe (ranges of elbow joint flexion and extension≤30°) , severe (ranges of elbow joint flexion and extension>30° but≤60°) , moderate (ranges of elbow joint >60° but<90°) , and mild (ranges of elbow flexion and extension≥90° but≤100°) . Comprehensive conservative treatment is recommended to treat post-traumatic elbow stiffness of fewer than 6 months without bone structure problem. Currently, rehabilitation treatment mainly includes functional exercises, stretching braces, shortwave, ultrasound therapy, internal and external application of Chinese medicine, massage, manual massage, and drug fumigation. There is a big difference in the efficacy of conservative treatment for different degrees of post-traumatic elbow stiffness, which is related to the original diagnosis, violence, surgical conditions, and immobilization duration. The greater the degree of stiffness, the relatively poorer the conservative treatment effect. At present, no report has been retrieved for the analysis of rehabilitation effects for patients with different degrees of elbow stiffness.

To observe the short-term efficacy of comprehensive rehabilitation for severe post-traumatic elbow stiffness (range of motion ≤60°) and analyze the related factors.

A retrospective study was conducted on the inpatients in our department from January 2017 to December 2020. All the patients were treated with a comprehensive rehabilitation program of traditional Chinese and western medicine, including joint loosening maneuver, static stretching brace therapy, active exercise therapy, cold therapy, and Chinese medicine external application. The data of patients who meet the diagnostic and inclusive criteria were analyzed, and the range of motion, pain (VAS score) , hospital of special surgery (HSS) score of elbow function, ability of daily living (ADL) , and improved range of motion were compared between prehospitalization and discharge. The groups were divided according to the improved range of motion. The patients with improved range of motion over 40° were divided into group A, and then those with improved range of motion less than or equal to 40° were divided into group B. Univariate and multivariate regression analyses were performed for gender, age, size of violence, length of hospital stay, course of the disease, operation or not, combined with myositis ossificans or not, combined with ulnar neuritis or not, open injury or not, combined with shoulder or wrist stiffness or not, and complicated elbow injury or not in the two groups.

The range of motion, pain (VAS score) , HSS score, and ADL score were compared between prehospitalization and discharge. The above indicators were compared and analyzed by independent sample t-test (P=0.000) , and there was a statistically significant difference. However, only 29.7% of HSS scores were above 70. The mean value of improved range of motion was 28.12°, P 50 =25°, and P 75 =40°. According to the degree of improved range of motion, there were 32 patients in group A and 69 patients in group B. There was no statistical difference between the two groups in the range of motion before and after treatment. Regression analysis confirmed that complex elbow injury, age over 45 years old, and disease course over 6 weeks were independent risk factors affecting the short-term efficacy of severe post-traumatic elbow stiffness.

There are limitations to the short-term efficacy of severe post-traumatic elbow stiffness. In the rehabilitation of patients with severe post-traumatic elbow stiffness, early intervention (within 6 weeks) should be paid particular attention to middle-aged and elderly patients with complex elbow injuries.