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

Mader, Konrad; Koslowsky, Thomas Christian; Gausepohi, Thomas; Pennig, Dietmar
March 2007
Journal of Bone & Joint Surgery, American Volume;Mar2007 Supplement, Vol. 89-A, p26
Academic Journal
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. lntraoperative range of motion under distraction reached a mean of 1000. 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.


Related Articles

  • Treatment of Unreduced Elbow Dislocations with Hinged External Fixation. Jupiter, Jesse B.; Ring, David // Journal of Bone & Joint Surgery, American Volume;Sep2002, Vol. 84-A Issue 9, p1630 

    Background: The results of operative treatment of an unreduced elbow dislocation have been regarded with pessimism. Suggested procedures have included tendon-lengthening, tendon transfer, or reconstruction of ligament or bone. Methods: Three women and two men (average age, forty-nine years) with...

  • Guyon tunnel syndrome secondary to excessive healing tissue in a child: a case report. Kalacı, Aydıner; Doğramacı, Yunus; Sevinç, Teoman Toni; Yanat, Ahmet Nedim // Journal of Brachial Plexus & Peripheral Nerve Injury;2008, Vol. 3, Special section p1 

    We describe a case of an 8-year-old boy who developed a combined motor and sensory neuropathy of the distal ulnar nerve, after sustaining a superficial injury to the right flexor carpi ulnaris tendon at the level of the distal wrist crease. Guyon's canal syndrome is a very rare entity during...

  • HINGED ELBOW EXTERNAL FIXATION FOR SEVERE ELBOW CONTRACTURE. Ring, David; Hotchkiss, Robert N.; Guss, Daniel; Jupiter, Jesse B. // Journal of Bone & Joint Surgery, American Volume;Jun2005, Vol. 87-A Issue 6, p1293 

    Background: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open...

  • Postoperative Ulnar Neuropathy is not Necessarily Iatrogenic: a Prospective Study on Dynamic Ulnar Nerve Dislocation at the Elbow. Billmann, Franck; Bokor-Billmann, Therezia; Burnett, Claude; Lapshyn, Hryhoriy; Hopt, Ulrich; Kiffner, Erhard // World Journal of Surgery;Aug2014, Vol. 38 Issue 8, p1978 

    Background: Patients who undergo surgery may develop ulnar neuropathy. Although the mechanism of ulnar neuropathy is still not clear, ulnar neuropathies are common causes of successful lawsuits against surgeons. Recently, the concept developed that endogenous patient factors can lead to...

  • A More Useful Milking Maneuver. Sallis, Robert E.; Bach, Bernard R. // Physician & Sportsmedicine;Jul2005, Vol. 33 Issue 7, p17 

    The article presents information on a modification of the traditional milking maneuver used for examining medial elbow. The modified milking maneuver is a dynamic test throughout the arc of motion of the elbow and may pinpoint the medial structure most likely affected, such as the anterior band...

  • Complications of Hinged External Fixation Compared With Cross-pinning of the Elbow for Acute and Subacute Instability. Ring, David; Bruinsma, Wendy; Jupiter, Jesse // Clinical Orthopaedics & Related Research;Jul2014, Vol. 472 Issue 7, p2044 

    Background: Elbows that are unstable after injury or reconstructive surgery often are stabilized using external fixation or cross-pinning of the joint supplemented by cast immobilization. The superiority of one approach or the other remains a matter of debate. Questions/purposes: We compared...

  • The Management of Elbow Instability Using an Internal Joint Stabilizer: Preliminary Results. Orbay, Jorge; Mijares, Michael // Clinical Orthopaedics & Related Research;Jul2014, Vol. 472 Issue 7, p2049 

    Background: Nonsurgical and surgical treatments such as immobilization, transarticular pinning, and hinged or nonhinged external fixation have been used to treat unstable elbows. These methods all have drawbacks. We thought that a bent Steinmann pin introduced through the axis of ulnohumeral...

  • Don't use hip spica in kids with femoral fracture.  // BMJ: British Medical Journal (International Edition);7/9/2005, Vol. 331 Issue 7508, p58 

    Discusses whether external fixation is more effective than hip spica casting in preventing malunion in children with femoral fractures. Description of a study of children admitted to hospitals with fractures; Assertion that external fixation of pediatric diaphyseal femoral fractures...

  • Management of the floating elbow injury in children : Simultaneous ipsilateral fractures of the elbow and forearm. Harrington, Paul; Sharif, Imran; Fogarty, Esmond E.; Dowling, Frank E.; Moore, David P. // Archives of Orthopaedic & Trauma Surgery;Mar2000, Vol. 120 Issue 3/4, p205 

    Simultaneous ipsilateral fracture of the elbow and forearm – floating elbow – is an uncommon injury. During a 7-year period we prospectively followed 12 children who presented with completely displaced supracondylar fractures of the humerus associated with a forearm fracture of the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics