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
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.