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Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents

Piper, Samantha L., MD*,†; Lattanza, Lisa L., MD; Shen, Tony S., BS*; Wall, Lindley B., MD*; Goldfarb, Charles A., MD*

Journal of Pediatric Orthopaedics: May/June 2019 - Volume 39 - Issue 5 - p 241–246
doi: 10.1097/BPO.0000000000000923
Trauma
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Background: Posttraumatic elbow contractures in children and adolescents are challenging to manage, and studies investigating surgical treatment are limited by the rarity of this condition. Small case series have shown variable gains in immediate and long-term elbow arc of motion after open surgical release. We reviewed our experience with open surgical release of posttraumatic elbow contracture in patients <21 years old at 2 institutions.

Methods: A retrospective chart review identified patients who underwent posttraumatic open elbow contracture release by 2 surgeons at 2 institutions between 2006 and 2013. Nontraumatic contractures and arthroscopic releases were excluded. Twenty-six patients were included in this study. Mean age at the time of injury was 12 years (5 to 19 y) and at the time of surgery was 14 years (7 to 20 y). Capsulotomy, osteoplasty, removal of hardware, ulnar nerve release or transposition, and ligament reconstruction were performed through medial and lateral approaches as indicated by the pathology. Ten patients had ligament repair or stabilization, and 16 patients used a continuous passive motion (CPM) postoperatively. Outcomes included active range of motion and complications.

Results: Mean time from injury to surgical release was 29 months. Mean postoperative follow-up was 42 months. Elbow active flexion-extension and forearm rotation arcs both increased significantly by a mean of 49 and 70 degrees, respectively, at final follow-up. A mean 85% of intraoperative flexion-extension arc was maintained at final follow-up. Ligament repair or reconstruction and the use of a postoperative CPM did not significantly change these outcomes. Outcomes were not significantly different if our contracture release was performed within a year from injury. Patients who had surgery before our contracture release had decreased restoration of forearm rotation after release. Complications included 2 recurrent contractures (1 used a CPM and 1 did not), and 2 postoperative ulnar neuropathies (1 used a CPM and 1 did not).

Conclusions: Open contracture release for posttraumatic elbow contracture in an adolescent population can significantly improve active range of motion.

Level of Evidence: Level 3—therapeutic.

*Department of Orthopaedic Surgery, Washington University, St. Louis, MO

San Francisco Department of Orthopaedic Surgery, University of California, San Francisco, CA

Supported by the grant, National Center for Advancing Translational Sciences UL1 TR000448.

The authors declare no conflicts of interest.

Reprints: Charles A. Goldfarb, MD, Department of Orthopaedic Surgery, Washington University, 4921 Parkview Place, St. Louis, MO 63110. E-mail: Goldfarbc@wudosis.wustl.edu.

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