Surgical Treatment of Posttraumatic Elbow Contractures in Adolescents

Author(s): Bae DS, Waters P

Source: J Pediatr Orthop 21:58-584, 2001

Summary:

A single surgeon's experience with surgical release for posttraumatic elbow contracture in adolescents is presented. Thirteen adolescents with recalcitrant elbow contractures were reviewed retrospectively. All patients developed contracture after fracture „b dislocation. The medial approach was favored in most cases with anterior and posterior capsulectomy, debridement of the olecranon and coronoid fossa, and preservation of collateral ligaments. Heterotopic ossification was removed in 5 cases. Continuous passive motion was instituted immediately after surgery in all patients.

Average follow-up was almost 30 months. Two patients were lost to follow-up. Elbow extension loss improved from 58„a to 15„a. Elbow flexion increased from 110„a to 123„a. Total arc improved an average of 54„a. Complications occurred in 3 patients and included ulnar neuropraxia, wound dehiscence, and considerable recalcitrant pain attributed to articular degeneration found at surgery.

This study expands the established principles of adult elbow contracture release to the adolescent population. Similar surgical principles include a wide exposure, capsular resection, removal of heterotopic bone, and early postoperative motion. Complications occurred in 3 of the 13 patients, which highlights the complexity of the procedure. The ultimate range of motion averaged 40„a to 145„a (average gain of 54„a), which restored sufficient motion for most activities of daily living. This patient population must be treated with caution, however, as others have reported a higher degree of failures following elbow release in adolescent individuals.

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