Management of post-traumatic elbow stiffness in paediatric and adult patients: an update

Abstract

Posttraumatic elbow stiffness can have a large impact on the ability of a patient to perform activities of daily living. Following a stepwise approach to treatment helps clinicians in this otherwise difficult-to treat condition. Treatment in adults is based on dealing with the involvement of soft tissue contracture, osseous impingement or both. Unlike adults, posttraumatic elbow stiffness in children has distinctly different causes and the thrust of treatment is primarily non-surgical. In skeletally immature children, the skeletal growth potential should be properly assessed and closely followed, observing either progression or natural correction of the deformity. Early active motion aided by physiotherapy is the first step in treatment for both adults and children. Following physiotherapy, brace therapy is a proven cheap and effective therapy for treatment-resistant stiffness. If adequate conservative treatment is unsuccessful, the next step is surgical arthrolysis. This procedure can be performed either open or arthroscopically, with the decision dependent on multiple factors. Early active mobilization after surgery is equally important, with the addition of bracing or continuous passive motion (CPM) in pending contractures following surgery. This paper provides a review of the current literature and a state-of-the-art guidance on the management of posttraumatic elbow stiffness in adult and paediatric patients.