The Crooked Truth about Elbow Surgery for Children

"Contracture" is the term used to describe stiffness that keeps a joint from fully straightening or bending. Contracture of the elbow can result from problems at birth or from trauma such as a fracture. If caught quickly, this problem can be treated with physical therapy and splinting. Otherwise, surgery may be needed to create more movement in the joint.

Few studies report the results of surgery for elbow stiffness in young patients who don't have muscular diseases. After treating adults and kids with this problem, it seemed to these authors that elbow surgery wasn't as successful for patients under the age of 21. They reviewed the cases of 37 patients who had elbow surgery. The patients were 10 to 20 years old, with an average age of 16. Most of the patients had elbow stiffness due to fractures. They had all tried other treatments without success. About half of them had already had elbow surgery.

Surgeons "released" the ligament enclosure (joint capusle) around the elbow. They also removed any bone or other material that might get in the way of elbow movement. They did not try to lengthen the muscles or tendons. After surgery, patients wore elbow splints for three months, 16 hours a day. When not in splints, patients did exercises to improve elbow movement.

About a year after surgery, patients' elbow motion had improved. However, these improvements were small and unpredictable. Only 75 percent of patients gained more than 10 degrees of elbow movement. Less than half of them achieved the amount of elbow movement necessary for activities of daily living. Two patients actually lost movement. Older kids in the study were a little more likely to get better results from surgery. But in general, their results were not as good as those seen in adults.

Patients with some types of injuries fared better than others. Patients who had fractures outside the elbow joint or simple dislocations of the elbow did better than patients who had joint fractures or fractures plus dislocations. Patients were more likely to have good results if they had not already undergone elbow surgery. They also had better results when loose pieces of bone and other material were removed during surgery.

The authors conclude that this surgery is less helpful for children than for adults. Improved but not normal elbow movement can be expected for most children who have surgery for elbow stiffness. Doctors should advise younger patients and their parents of this to avoid unrealistic expectations.

References: Anthony A. Stans, MD, et al. Operative Treatment of Elbow Contracture in Patients Twenty-one Years of Age or Younger. In The Journal of Bone and Joint Surgery. March 2002. Vol. 84-A. No. 3. Pp. 298-303.