Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

Abstract

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.

Arthroscopic Surgery in Children and Adolescent – A Domain to Be Developed

“…dislocation is an invalidating condition needing surgery [15] to restore the range of motion. Foreign body removal using arthroscopic tools is an attractive alternative allowing early start of rehabilitation.…”

Multiple rare causes of post-traumatic elbow stiffness in an adolescent patient: a case report and review of literature

“…The goal of progressive ROM is to increase this motion by lengthening and isolating tissue, not by tearing tissue. Kruse et al[9] reported a technique that maximized elbow ROM by combining lateral and minimal posterior triceps-splinting open elbow contracture release, and the use of a splint with the elbow at 20° of flexion and the forearm neutral at the end of the procedure, which is a safe and effective alternative[10]. However, in the present case, after removing soft tissue contracture and performing complete neurolysis of the left radial nerve surrounding the incision, we found excessive tension of the radial nerve at an elbow flexion of 30° intraoperatively (Figure 6C).…”

“…Many studies have shown that it is necessary to perform trans-position of the ulnar nerve intraoperatively to avoid delayed-onset ulnar neuritis and other complications[19,20]. Similarly, some studies showed that the ulnar nerve should be mobilized and retracted anteriorly[10]. However, although subcutaneous ulnar nerve transposition is performed during open arthrolysis for posttraumatic elbow stiffness, ulnar neuritis is still an important complication[21].…”