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

¹ Department of Trauma Surgery, Hand and Reconstructive Surgery, St.Vinzenz-Hospital, Merheimer Strasse 221-223, D-50733 Cologne, Germany. E-mail address for K. Mader: k.mader{at}ndh.net

Investigation performed at the Department of Trauma Surgery, Hand and Reconstructive Surgery, St.Vinzenz-Hospital, Cologne, Germany

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. One or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Orthofix Inc., McKinney, Texas). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.

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