Operative treatment of elbow contracture in patients twenty-one years of age or younger

Background: Elbow contracture is a recognized sequela of traumatic and developmental elbow disorders, but little information is available regarding the surgical treatment of elbow stiffness in the pediatric population. Methods: Thirty-seven patients who had had open surgical release of an elbow contracture at a mean age of sixteen years (range, ten to twenty years) were retrospectively studied after a mean duration of follow-up of fifteen months (range, six to forty-four months). The elbow contracture was posttraumatic in twenty-eight patients. The operation consisted of a capsular release with removal of osseous impediments to motion as necessary. No patient had muscle or tendon-lengthening. Results: The total arc of motion improved from a mean of 66° preoperatively to a mean of 94° postoperatively; however, only twenty-eight patients (76%) had an improvement of ≥10° and only seventeen (46%) achieved a functional arc of motion of 100° (from 30° to 130°). Two patients lost motion after surgery. These results are less favorable than the results of previous studies of both pediatric and adult patients. Patients in whom the contracture had been caused by a simple dislocation of the elbow or an extra-articular fracture tended to have better results than those in whom the contracture was due to other causes. Conclusions: The results of surgical treatment of elbow stiffness in pediatric patients are less favorable and less predictable than those in adult patients.