title: Outcomes after operative treatment of elbow contractures in the pediatric and adolescent population.
abstract: BACKGROUND
  The role of elbow contracture release in the very young is unclear, with existing studies reporting conflicting results. This study evaluated the long-term results after open elbow contracture release in patients aged younger than 18 years.
  
  
  METHODS
  Between 1994 and 2012, 32 patients underwent open elbow contracture release at a mean age of 13.8 years (range, 5-18 years), and their outcomes were reviewed. The primary cause was traumatic in 30 patients (4 radial head/neck fractures, 5 intra-articular distal humeral fractures, 11 extra-articular distal humeral fractures, 10 complex fracture-dislocations), and the mean time from the index injury to contracture release was 16.3 months (range, 3-82 months). The cause in 2 patients was nontraumatic (1 osteochondritis dessicans, 1 congenital). The mean follow-up period was 66 months (range, 7-202 months).
  
  
  RESULTS
  At the latest follow-up, total arc of motion improved from 69° to 123° (P <.0001), with a mean increase of 54° (P <.0001). The function arc was >100° in 28 patients (88%), and 29 patients (91%) achieved >20° of improvement in their arc. Twelve patients (38%) underwent a gentle manipulation under anesthesia at a mean of 2.7 weeks (range, 1-5 weeks) for early recurrence of stiffness. There were 3 complications (1 deep infection, 1 hematoma, 1 humeral fracture through the external fixator pin site). No patients lost motion after surgery.
  
  
  CONCLUSIONS
  Elbow contracture release in the pediatric and adolescent population can provide significant improvements in range of motion similar to that achieved in adults. The improvements in motion are durable.
authors.affiliation: Melbourne Orthopaedic Group and Department of Orthopaedic Surgery, Monash University, Dandenong Hospital, Melbourne, VIC, Australia.
authors.forename: Eugene T H
authors.initials: ET
authors.lastname: Ek
authors.affiliation: Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Sophia K
authors.initials: SK
authors.lastname: Paul
authors.affiliation: Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY, USA. Electronic address: Hotchkiss.r@gmail.com.
authors.forename: Robert N
authors.initials: RN
authors.lastname: Hotchkiss
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D015915:Motion Therapy, Continuous Passive; D011182:Postoperative Care; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D012399:Rotation
keywords: Elbow; adolescent; contracture; joint; pediatric; release; stiffness