Open surgical treatment of post-traumatic elbow contractures in adolescent patients

Darlis, N.A.; Kaufmann, Robert W.; Sotereanos, Dean G.

doi:10.1016/j.jse.2006.01.006

Cited by 27 publications

(14 citation statements)

References 30 publications

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“…7,8 We have found a more reliable improvement in range of motion if the pathology is isolated to soft-tissue contractures rather than intraarticular bony incongruency. Improvements in range of motion to between 60% to 100% of preoperative values can be expected.…”

Section: Postoperative Managementmentioning

confidence: 75%

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Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

Strauss

Lattanza²

2010

Techniques in Hand &Amp; Upper Extremity Surgery

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Posttraumatic elbow stiffness in children can be a severe obstacle to accomplishing basic activities of daily living, including dressing, and participating in recreational activities. The etiology of this stiffness is typically extrinsic or instrinsic pathology caused by an earlier supracondylar humerus fracture, elbow dislocation, or elbow fracture-dislocation. Children with functional limitations, typically associated with flexion contractures greater than 30 degrees or less than a functional arc (30 to 130 degrees) can benefit from surgical contracture release, which consistently improves range of motion.

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Section: Postoperative Managementmentioning

confidence: 75%

“…4,7,8 The lateral column approach was first described by Mansat and Morrey. 4,7,8 The lateral column approach was first described by Mansat and Morrey.…”

mentioning

confidence: 99%

Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

Strauss

Lattanza²

2010

Techniques in Hand &Amp; Upper Extremity Surgery

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“…5–8 All of these groups used either lateral or medial approaches, or both, and addressed both soft tissue and bony pathology. Only two patients out of all four studies required ligament repair (both MCL), 6 therefore no prior study of pediatric elbow contracture release has been able to evaluate the effects of ligament reconstruction on contracture release. Our study represents one of the largest studies to date of post-traumatic elbow contracture in pediatric and adolescent patients, and has the benefit of including a heterogeneous population from two institutions and two surgeons’ protocols.…”

Section: Discussionmentioning

confidence: 99%

Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents

Piper

Lattanza

Shen

et al. 2019

Journal of Pediatric Orthopaedics

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Background: Post-traumatic 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 post-traumatic elbow contracture in patients less than 21 years old at two institutions. Methods: A retrospective chart review identified patients who underwent post-traumatic open elbow contracture release by two surgeons at two institutions between 2006 and 2013. Non-traumatic contractures and arthroscopic releases were excluded. 26 patients were included in this study. Mean age at the time of injury was 12 years (5–19 years) and at the time of surgery was 14 years (7–20 years). 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. 10 patients had ligament repair or stabilization, and 16 patients used a CPM post-operatively. Outcomes included active range of motion and complications. Results: Mean time from injury to surgical release was 29 months. Mean post-operative follow-up was 42 months. Elbow active flexion-extension and forearm rotation arcs both increased significantly by a mean of 49° and 70°, respectively, at final follow-up. A mean 85% of intra-operative 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 prior to our contracture release had decreased restoration of forearm rotation after release. Complications included two recurrent contractures (one used a CPM and one did not), and two post-operative ulnar neuropathies (one used a CPM and one did not). Conclusions: Open contracture release for post-traumatic elbow contracture in an adolescent population can significantly improve active range of motion. Level of Evidence: Therapeutic 3

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“…However, few reports address open release elbow stiffness in children and adolescent patients. [1][2][3][4][5][6] Stans et al 4 reported that, compared with adults, results in children and adolescents are less predictable and less favorable. The goal of the current study was to demonstrate the results of managing posttraumatic elbow stiffness in children and adolescents.…”

Section: Open Release and A Hinged External Fixator For The Treatmentmentioning

confidence: 99%

Open Release and a Hinged External Fixator for the Treatment of Elbow Stiffness in Young Patients

Ouyang¹,

Wang²,

Li³

et al. 2012

Orthopedics

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Elbow stiffness is a well-recognized complication following elbow trauma, but little information is available regarding the surgical treatment of elbow stiffness in children and adolescents. This article presents the results of open arthrolysis with twin incisions and a hinged external fixator to treat severe elbow contracture in children and adolescents. Twenty-one patients (mean age, 14.9 years; range, 7-19 years) were evaluated. All patients underwent surgery using a hinged external fixator and a combined mediolateral approach to address the elbow contracture. Mayo elbow score and range of motion (ROM) were measured preoperatively and at 3, 12, and 24 months postoperatively. All but 1 patient achieved a functional ROM of 100°. Preoperatively, mean flexion was 70.2° (range, 30°-100°), extension was 42.6° (range, 0°-80°), and total ROM was 28.5° (range, 0° to 80°); postoperatively, mean flexion improved to 122.8° (range, 90°-140°), extension to 10° (range, 0°-30°), and total ROM to 114.5° (range, 60°-140°). The Mayo elbow score improved from a mean of 48 points (range, 35-65 points) to 90 points (range, 75-100 points), and 9 patients had excellent results, 7 had good results, 4 had fair results, and 1 had a poor result. No significant differences existed between postoperative measurements at 3, 12, and 24 months. No pin-tract infections or deep infections occurred, and no vascular or neurological complications were noted. Surgical treatment of elbow stiffness using a hinged external fixator and open arthrolysis is an effective procedure in children and adolescents.

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Open surgical treatment of post-traumatic elbow contractures in adolescent patients

Cited by 27 publications

References 30 publications

Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents

Open Release and a Hinged External Fixator for the Treatment of Elbow Stiffness in Young Patients

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