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

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 unfavor-able 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 under-gone 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 distrac-tion 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 su-pination was 56°. After a mean duration of follow-up of thirty-four months, all patients but two had achieved a func-tional 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 radio