{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T19:13:08Z","timestamp":1776712388441,"version":"3.51.2"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n            <jats:title>Objectives:<\/jats:title>\n            <jats:p>Evaluate the safety and efficacy of manipulation under anesthesia (MUA) for posttraumatic elbow stiffness.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Design:<\/jats:title>\n            <jats:p>Retrospective, case series.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Setting:<\/jats:title>\n            <jats:p>Single institution; level 1 trauma center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients\/Participants:<\/jats:title>\n            <jats:p>Chart review of 45 patients over a 10-year period treated with MUA for posttraumatic elbow stiffness after elbow injuries treated both operatively and nonoperatively.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Intervention:<\/jats:title>\n            <jats:p>None.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Main Outcome Measures:<\/jats:title>\n            <jats:p>Change in total flexion arc pre- to postmanipulation; time to manipulation; complications.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Average time from most recent surgical procedure or date of injury to MUA was 115 days. Average premanipulation flexion arc was 57.9 degrees; average flexion arc at the final follow-up was 83.7 degrees. The improvement in elbow flexion arc of motion was statistically significant (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001). Post hoc analysis of the data revealed 2 distinct groups: 28 patients who underwent MUA within 3 months of their most recent surgical procedure (early manipulation), and 17 patients who underwent MUA after 3 months (late manipulation). Average improvement in elbow flexion arc in the early MUA group was 38.3 degrees (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001); improvement in the late MUA group was 3.1 degree. Comparison of improvement between the early and late MUA groups found a significant difference (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.001) in mean flexion arc improvement from premanipulation to postmanipulation, favoring the early group. One patient had a complication directly attributable to MUA. Nineteen patients required additional procedures on the injured extremity after MUA.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>MUA is a safe and effective adjunct to improving motion in posttraumatic elbow stiffness when used within 3 months from the original injury or time of surgical fixation. After 3 months, MUA does not reliably increase elbow motion.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Level of Evidence:<\/jats:title>\n            <jats:p>Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000001222","type":"journal-article","created":{"date-parts":[[2018,7,23]],"date-time":"2018-07-23T10:36:24Z","timestamp":1532342184000},"page":"e304-e308","source":"Crossref","is-referenced-by-count":14,"title":["Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness"],"prefix":"10.1097","volume":"32","author":[{"given":"Clay A.","family":"Spitler","sequence":"first","affiliation":[{"name":"University of Mississippi Medical Center, Jackson, MS;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel H.","family":"Doty","sequence":"additional","affiliation":[{"name":"College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of Alabama-Birmingham, Birmingham, AL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter J.","family":"Nowotarski","sequence":"additional","affiliation":[{"name":"College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk W.","family":"Kiner","sequence":"additional","affiliation":[{"name":"College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel E.","family":"Swafford","sequence":"additional","affiliation":[{"name":"College of Medicine Chattanooga, University of Tennessee, Chattanooga, TN; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. 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