Clinical Outcomes Following Surgical Management of Post-Traumatic Elbow Contractures in the Pediatric Age Group: A Meta-Analysis and Systematic Review

James R Onggo; Nina S H Chua; Jason D Onggo; Kemble K Wang; Eugene T Ek

doi:10.1016/j.jhsa.2024.01.010

Clinical Outcomes Following Surgical Management of Post-Traumatic Elbow Contractures in the Pediatric Age Group: A Meta-Analysis and Systematic Review

J Hand Surg Am. 2024 Feb 26:S0363-5023(24)00026-1. doi: 10.1016/j.jhsa.2024.01.010. Online ahead of print.

Authors

James R Onggo¹, Nina S H Chua², Jason D Onggo², Kemble K Wang³, Eugene T Ek⁴

Affiliations

¹ Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia; Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia.
² Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia.
³ Department of Orthopaedic Surgery, Box Hill Hospital, Victoria, Australia; Department of Orthopaedic Surgery, Royal Children's Hospital, Victoria, Australia.
⁴ Department of Surgery, Monash Medical Centre, Monash University, Melbourne, VIC, Australia; Melbourne Orthopaedic Group, Melbourne, VIC, Australia. Electronic address: eugene.ek@mog.com.au.

PMID: 38416094
DOI: 10.1016/j.jhsa.2024.01.010

Abstract

Purpose: Post-traumatic elbow stiffness is a common occurrence resulting in potentially substantial functional limitations in both daily activities and recreational endeavors. In children, this can be particularly difficult given the early stages of childhood and development and the challenges of rehabilitation. Several studies have reported favorable results of elbow contracture releases in children, resulting in improvements in outcomes. This meta-analysis aimed to determine the efficacy and safety of elbow contracture releases in the pediatric population (<18 years), along with subgroup analyses comparing age groups, operative approach, and post-traumatic versus nontraumatic etiologies.

Methods: Meta-analysis was performed with a multidatabase search (PubMed, OVID, EMBASE, and Medline) according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines on September 25, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed.

Results: Seven studies were included, comprising 114 post-traumatic elbow contractures. Mean age was 13.7 years. Contracture releases of the elbow led to improvements in flexion-extension arc of motion by 48º, and pronosupination arc of motion by 22º. Subgroup analysis comparing age groups of <10, 10-14 and 15-18 years showed greater improvements in flexion-extension arc in the older age group, whereas subgroup analysis comparing injury patterns revealed a larger improvement in pronosupination motion for radial head fractures. Comparing open and arthroscopic procedures, open releases had greater improvement in both flexion-extension and pronosupination motion by 18º and 21º, respectively, although there were limited patients in the arthroscopy group.

Conclusion: Operative management of pediatric elbow contractures is effective. Older children, children with radial head fractures, and those receiving open contracture releases may be more likely to have greater improvements.

Type of study/level of evidence: Therapeutic IV.

Keywords: Adolescent; arthroscopy; elbow contracture; pediatric; post-traumatic; range of motion; stiffness; surgical release.