The Journal of Bone and Joint Surgery (American). 2007;89:26-35.
doi:10.2106/JBJS.F.01122
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents

Surgical Technique

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

1 Department of Trauma and Orthopedic 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 and Orthopedic Surgery, Hand and Reconstructive Surgery, St. Vinzenz-Hospital, Cologne, Germany

The original scientific article in which the surgical technique was presented was published in JBJS Vol. 88-A, pp. 1011-1021, May 2006

DISCLOSURE: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The line drawings in this article are the work of Jennifer Fairman (jfairman{at}fairmanstudios.com).

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 an 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.


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Related articles in JBJS:

Mechanical Distraction for the Treatment of Posttraumatic Stiffness of the Elbow in Children and Adolescents
Thomas Gausepohl, Konrad Mader, and Dietmar Pennig
JBJS 2006 88: 1011-1021. [Abstract] [Full Text]