Elbow Contractures In Children Research Articles

Physical treatment of posttraumatic elbow contractures in children – our experience

The most common complications of elbow trauma are contractures and neurovascular injuries. The complications can be a result of the initial injury, but they can also be a result of a surgical treatment. In addition to orthopedic treatment of elbow fractures, physical therapy and rehabilitation play a significant role in treatment of posttraumatic contractures. To determine the effects of physical therapy and rehabilitation of posttraumatic elbow contractures in children. This was a retrospective cross-sectional study conducted in the University Clinic for Physical Medicine and Rehabilitation, Skopje in the period 01.01.2021 – 01.07.2022. A total of 52 children were included, at the age between 2 and 13 years who had a posttraumatic elbow contracture, limited range of motion, pain and/or limitations in accomplishing daily activities. Depending on the clinical finding, children underwent a relevant physical therapy (kinesitherapy, functional therapy, electrotherapy, thermotherapy, hydrotherapy and magnetotherapy) in duration of three weeks. For assessing the effects of the rehabilitation therapy, the range of motion of the elbow and forearm was examined along with the Flynn’s scale in all children, prior to and after completion of the physical treatment. Applied physical treatment resulted in a significant improvement in all analyzed movements such as: elbow flexion (p=0.00001), elbow extension (p=0.00001), forearm pronation (p=0.00001), forearm supination (p=0.0000) and Flynn’s scale (p=0.0000). After completion of the rehabilitation treatment, excellent results were registered in 41 (85%) children, moderate in 10 (19.23%) and favorable in 1 (1.92%). Timely and adequate application of physical therapy and rehabilitation can significantly improve the final outcome in treatment of posttraumatic elbow contractures in children. A combination of different physical procedures adequately applied and personalized can significantly improve the range of motion of the elbow.

Новые подходы к лечению детей с посттравматическими контрактурами локтевого сустава

Abstract. Introduction Post-traumatic elbow contracture is a severe disabling condition of childhood that interferes with both physical and psychic aspects for the child. A high rate of poor results encourages surgeons seek for better surgical treatments. Current diagnostic modalities were practical to get the clinical picture of the contracture mechanogenesis and determine the treatment strategy. The goal of the study was to review long-term results of new surgical techniques developed for post-traumatic elbow contractures in children. Material and methods The inpatient records of 102 pediatric patients with post-traumatic elbow contractures operated on with the technique offered were reviewed. All patients underwent conventional radiological, ultrasound and MSCT examinations. Results Based on the pathobiomechanics of the injured elbow a mobilization technique was developed to ensure complete bone realignment, relieve pain and allow early exercises for the joint. Postoperative lavage of the joint cavity, intra-articular administration of corticosteroids and polyvalent enzymes in the early postoperative period facilitated improved long-term outcomes of elbow contractures. All patients reported good results. Discussion Tenotomies of the lateral ligaments can be added to arthrotomy and reconstruction of articular surfaces for temporary instability of the joint to restore movement in the elbow joint in severe cases. Post-traumatic elbow contractures are accompanied by impaired biomechanics. MSCT and 3D reconstruction of bone structures is the gold standard in the diagnosis of post-traumatic elbow contractures. Conclusion Bone impingements are to be addressed and an extended mobilization of the capsular ligamentous complex be provided for complete movement recovery through partial elbow instability to be temporarily ensured. Prolonged lavage of the elbow joint can be used to prevent adhesions and allow early elbow exercises and provide improved outcomes.

Response to "Observation About 'Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents'".

Response to "Observation About 'Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents'".

Open Surgical Release of Posttraumatic Elbow Contracture in Children and Adolescents.

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. 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. 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). Open contracture release for posttraumatic elbow contracture in an adolescent population can significantly improve active range of motion. Level 3-therapeutic.

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

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.

Open Surgical Treatment of Posttraumatic Elbow Contractures in Children

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.

Functional outcome of posttraumatic elbow contractures

Posttraumatic elbow contractures can cause functional limitations and impairment of activities of daily living in children and adults. The aim of this study was to investigate the outcome and differences between posttraumatic elbow contractures in children and adults during rehabilitation. We analyzed 68 patients with posttraumatic elbow contractures, who had been admitted to the regional rehabilitation center and managed by procedures of physical therapy. All patients were divided into two groups: group A (34 children) and group B (34 adults). Mayo Clinic Performance Index for Elbow (MCPI) was measured at the beginning and at the end of the physical treatment for each patient. Out of the study sample, 76.47% of children and 47.06% of adult patients had excellent score at the end of the therapy. The median of Performance index increased for both groups after the physical therapy and the differences were significantly high for both groups, children (t = 5.66, p < 0.001) and adults (t = 2.47, p < 0.001). MCPI at the discharge was significantly higher in the children than in the adults (t = 2.85, p < 0.05). The results of our investigation have shown that the elbow function assessment in patients with posttraumatic elbow contractures (in regard to pain, motion, stability and sum of daily function) was better in children than in adults at discharge, after approximately 3 weeks of rehabilitation.

Serial Casting and Splinting of Elbow Contractures in Children With Obstetric Brachial Plexus Palsy

Elbow flexion contractures are a common sequela in obstetric brachial plexus palsy. The etiology and best management of these contractures is unclear. Nonsurgical treatment involving serial casting and splinting is supported in the literature. The purpose of this study is to evaluate the effectiveness of serial casting and splinting of elbow flexion contractures in children with obstetric brachial plexus palsy. A retrospective review of children with obstetric brachial plexus palsy who participated in serial casting and splinting for an elbow flexion contracture was conducted. Elbow extension passive range of motion measurements at initial, best-achieved, and final outcome were compared. Nineteen patients, aged 2 to 16 years, were studied. Elbow passive range of motion improved from initial to best-achieved and final outcome measurements. Fifty-three percent of patients were noncompliant between the time of best-achieved and final outcome. Loss of passive range of motion during the noncompliant period was statistically significant. Compliant patients had better treatment results. A clinical decision tree for elbow contractures in obstetric brachial plexus palsy was formulated. Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy is effective. Successful maintenance of treatment effects is dependent on patient age and compliance. Therapeutic IV.

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents

Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees . Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. The mean preoperative arc of total elbow motion was 37 degrees . The mean pronation was 46 degrees , and the mean supination was 56 degrees . After a mean duration of follow-up of thirty-four months, all patients but two had achieved an arc of motion of 100 degrees . The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees ). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees ), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees ). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.

Therapeutically effect of the physical procedures on the elbow contractures in children with supracondylar humerus fractures

Supracondylar humerus fractures are the most common fracture around the elbow in the pediatric population. These fractures in children may lead to functional disturbance with loss or reduction of range of motion in the elbow joint. The aim of this study was to investigate the effect of the physical therapy on the range of the motion of the elbow joint in the post-traumatic elbow contractures in the childhood after supracondylar fractures. We analyzed in this research 34 children (average age 8.57+/-2.94 years) with elbow contractures that were treated by physical therapy after orthopedic treatment. Functional outcome was presented in degree from 1 to 3 (Flynn). The difference in the grade at the beginning and the end of the therapy is statistically significant (t=16.38, p<0.001). 91.18 %, of the children had excellent result. Complex of various therapeutically physical procedures can significant improve range of motion of the elbow joint.

MECHANICAL DISTRACTION FOR THE TREATMENT OF POSTTRAUMATIC STIFFNESS OF THE ELBOW IN CHILDREN AND ADOLESCENTS

Background: Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Methods: Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100°. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. Results: The mean preoperative arc of total elbow motion was 37°. The mean pronation was 46°, and the mean supination was 56°. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100°. The mean arc of flexion-extension was 108° (range, 75° to 130°). The mean range of pronation was 73° (range, 20° to 90°), and the mean range of supination was 75° (range, 10° to 90°). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Conclusions: Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents. Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents

Elbow contracture is a recognized sequela of elbow injuries in children and adolescents, but previous studies of operative treatment with formal capsular release have demonstrated unpredictable outcomes and unfavorable results. Over a period of five years, fourteen children and adolescents with a mean age of fourteen years who had posttraumatic stiffness of the elbow were managed according to a prospective protocol. Eleven patients had undergone a mean of three previous operative procedures before the index operation. After intraoperative distraction with an external fixator, there was a relaxation phase for six days followed by mobilization of the elbow joint under distraction in the fixator for a mean of seven weeks. Intraoperative range of motion under distraction reached a mean of 100 degrees. Open arthrolysis was not performed, but in four children impinging heterotopic bone was removed through a limited approach. Decompression of the ulnar nerve was performed in seven patients. The mean preoperative arc of total elbow motion was 37 degrees. The mean pronation was 46 degrees, and the mean supination was 56 degrees. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a functional arc of motion of 100 degrees. The mean arc of flexion-extension was 108 degrees (range, 75 degrees to 130 degrees). The mean range of pronation was 73 degrees (range, 20 degrees to 90 degrees), and the mean range of supination was 75 degrees (range, 10 degrees to 90 degrees). There were no pin-track infections or deep infections, and all elbows were stable. At the time of follow-up, three patients had radiographic evidence of humeroulnar degeneration. Closed distraction of the elbow joint with use of a monolateral external fixation frame with motion capacity yields more favorable results than other previously reported options for the treatment of posttraumatic elbow contractures in children and adolescents.

Surgical treatment of elbow contractures in postburn children.

One-hundred and forty-six postburn elbow contractures in children were classified into four categories--simple band, complex band (crosses shoulder and/or wrist joint), diffuse scar, and limited scar--to assess the results of surgical treatment. The best results were seen in children less than 5 years of age and in children with less than 50 percent third-degree total body surface area burns. Types of release included skin grafts, local flaps (with or without graft), and deep releases. Generally, good to excellent results were seen regardless of technique of release, and in no case was the postoperative contracture worse than the preoperative contracture. Full extension was restored in 82 percent of contractures that were less than 50 degrees and in 50 percent of contractures greater than 50 degrees. Major complications were uncommon, with 4 of 171 elbows requiring reoperation because of skin-graft or flap loss. Repeat releases were of minimal functional benefit.