Abstract Background: Posttraumatic contracture of the elbow (either flexion or extension) is sometimes very dis- abling. However, an absolutely convincing surgical tech- nique has not yet been defined in the literature. We devel- oped an intraarticular technique to concomitantly treat both intraarticular and extraarticular lesions with one pos- terior incision. Methods: Twenty consecutive adult pa- tients were treated. After the olecranon was osteotomized, all intraarticular pathologies and the anteroposterior cap- sule were corrected completely. The olecranon was then stabilized with the modified tension band wiring technique. Immediately postoperatively, continuous passive move- ment was performed, and range-of-motion exercise of the elbow was encouraged continuously. Results: All 20 pa- tients were followed up for a median of 3.8 (range 2.1–6.6) years. The satisfactory rate was 95% (19 of 20, p<0.001). The flexion contracture improved from an aver- age of 42 to 13 deg (p<0.001), and the maximal flexion improved from an average of 89 to 131 deg (p<0.001). The arc of motion improved from an average of 47 to 118 deg (p<0.001). The sole unsatisfactory patient still had 20– 110 deg of arc of motion. There were no evident compli- cations noted. Conclusion: Compared with other techniques, we recommend this one due to its high satisfactory rate and low complication rate. Keywords Posttraumatic contracture · Intraarticular technique · Tension band technique Introduction Although traumatic contracture of the elbow (either flex- ion or extension) is not uncommon, it is sometimes very disabling [16, 18, 24]. Clinically, it may be caused by ei- ther high- or low-energy injury, and the pathology can be due to intrinsic (intraarticular), extrinsic (extraarticular), or combined lesions [16, 17, 24]. If adequate treatment is delayed, the contracture will further deteriorate and be- come much more difficult to treat. Articles reporting such a disorder are few, and the methods of treatment have not yet been well defined. Despite that both conservative and surgical techniques have been advocated, none are ab- solutely convincing. The reported satisfactory rate is 70– 80% [24, 25, 28]. Traditionally, the treatment of traumatic contracture of the elbow tends to be conservative methods first. If they fail, open techniques are tried. However, until now a con- vincing surgical technique has not yet achieved consistent support. Because either an intraarticular or extraarticular lesion alone can induce the contracture of the elbow [16, 18, 19, 24, 26] and the lesion may be difficult to ascertain before the operation, theoretically both lesions had better be explored during the operation. Then the outcome after the operation could improve. However, a convincing sur- gical technique which can concomitantly explore both in- traarticular and extraarticular lesions has not yet been re- ported in the literature. Following the advancement of concepts and techniques in the treatment of complicated fractures involving the el- bow joint [2, 7, 8, 12, 15], a surgical technique which can expose both intraarticular and extraarticular lesions be- comes simpler and more satisfying. The aim of this prospec- tive study was to develop a more convincing surgical tech- nique to treat such a disabling disorder. Patients and methods From October 1994 to December 1999, 20 consecutive adult pa- tients (>16 years old) who sustained a traumatic contracture of the elbow joint (either flexion or extension) were treated by this surgi- cal technique at our institution. The patients were aged 32 (range 19–48) years with a male to female ratio of 4:1. There were 13 left elbows and 7 right. There were no bilateral disorders. The cause of elbow injury included motorcycle accident (n=10), machine com- pression (n=7), fall from a height (n=3). Besides the elbow injury, Chi-Chuan Wu Posttraumatic contracture of elbow treated with intraarticular technique Arch Orthop Trauma Surg (2003) 123 : 494–500 DOI 10.1007/s00402-003-0519-7 Received: 30 September 2002 / Published online: 27 May 2003 ORIGINAL ARTICLE C.-C. Wu (✉) Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, 333 Kweishan, Taoyuan, Taiwan Tel.: +886-3-3281200 ext. 2163, Fax: +886-3-3278113, e-mail: ccwu@mail.cgu.edu.tw © Springer-Verlag 2003