The Journal of Bone and Joint Surgery (American). 2006;88:1011-1021.
doi:10.2106/JBJS.D.02090
© 2006 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow [Supplementary Material]
Right arrow Letters to the Editor: Submit a response
Right arrow Letters to the Editor: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Related articles in JBJS
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gausepohl, T.
Right arrow Articles by Pennig, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gausepohl, T.
Right arrow Articles by Pennig, D.
Related Collections
Right arrow Elbow
Right arrow Pediatrics
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?

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

Thomas Gausepohl, MD1, Konrad Mader, MD1 and Dietmar Pennig, MD1

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.

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.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?

Related articles in JBJS:

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents. Surgical Technique
Konrad Mader, Thomas Christian Koslowsky, Thomas Gausepohl, and Dietmar Pennig
JBJS 2007 89: 26-35. [Abstract] [Full Text]  



Letters to the Editor:

Read all Letters to the Editor

Functional Arc of Motion
Shawn W. O'Driscoll, Ph.D., M.D.
JBJS Online, 27 Sep 2006 [Full text]