Combined Elbow Release and Humeral Rotational Osteotomy in Arthrogryposis.

Abstract

PURPOSE:

The purpose of this study was to determine if a simultaneous posterior elbow release and humeral osteotomy to correct both the elbow extension contracture and the humeral internal rotation contracture in children with arthrogryposis can produce similar results as a posterior elbow release alone.

METHODS:

This study was a retrospective chart review of consecutive patients with arthrogryposis treated surgically for elbow extension contracture between 2007 and 2014. A total of 43 procedures in 36 patients had adequate available follow-up data and were included in the study. The postoperative range of motion reported was measured at the early follow-up (3-6 months), midterm follow-up (between 1 and 2 years), and the most recent long-term follow-up (after 2 years) from the date of surgery. Patients were grouped into 2 groups (simultaneous and release) based on the necessity of performing an ipsilateral humeral rotation osteotomy at the time of the release.

RESULTS:

At early follow-up, patients in both groups increased their total arc of motion. There was a significant difference in extension and arc of motion at midterm follow-up (between 1 and 2 years) between the simultaneous and the release groups with the simultaneous group significantly losing both terminal extension and total arc of motion. At more than 2 years follow-up, there remained a statistically significant difference in arc of motion, with the release group having a significantly larger arc of motion. Patients who underwent dual plating had a much larger arc of motion at early follow-up than the K-wire or single-plate fixation group, despite having similar preoperative extension, flexion, and arc of motion. This difference was also significant at late follow-up.

CONCLUSIONS:

Patients with posterior release alone had significantly greater improvement in total arc of motion and significantly better elbow extension than patients who underwent a simultaneous humeral osteotomy. However, rigid fixation with early mobilization may yield results comparable with the release alone group.

TYPE OF STUDY/LEVEL OF EVIDENCE:

Therapeutic IV.

• Authors: Rey N Ramirez, Christopher J Richards, Scott H Kozin, Dan A Zlotolow
• Journal: The Journal of hand surgery (J Hand Surg Am) Vol. 42 Issue 11 Pg. 926.e1-926.e9 (Nov 2017) ISSN: 1531-6564 [Electronic] United States
• PMID: 28716382 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Arthrogryposis (diagnostic imaging, surgery)
• Bone Nails
• Bone Plates
• Child
• Child, Preschool
• Cohort Studies
• Combined Modality Therapy
• Contracture (diagnostic imaging, surgery)
• Elbow (diagnostic imaging, surgery)
• Exercise Therapy (methods)
• Female
• Humans
• Humerus (diagnostic imaging, surgery)
• Male
• Orthopedic Procedures (methods)
• Osteotomy (instrumentation, methods)
• Postoperative Care (methods)
• Prognosis
• Radiography (methods)
• Range of Motion, Articular (physiology)
• Recovery of Function
• Retrospective Studies
• Rotation
• Treatment Outcome