WOFAPS 2025 8th World Congress of Pediatric Surgery

Liu Xin

Sichuan province Orthopaedic Hospital,China

Purpose: To investigate the choice of surgical treatment modalities and to analyze their treatment efficacy in children with chronic elbow dislocation with extremely severe periarticular stiffness. Methods: Data of 21 children with chronic elbow dislocation with extremely severe periarticular stiffness diagnosed and treated in our department between February 2015 and February 2021 were retrospectively analyzed. Twenty boys and one girl were included in the study, their mean age was 11 ± 2.5 (range, 5.8–14) years, and they had concomitant distal humerus fractures. For the treatment protocol, all children with extremely severe elbow stiffness were treated with open arthrolysis, and elbow joint stability was intraoperatively assessed. Non-union fractures were treated by internal fixation with bone grafting. Malunion fractures affecting elbow joint movement or stability were treated with open reduction and internal fixation. Intra-articular loose bodies and heterotopic ossification in the elbow joint were completely resected, and elbow joint instability was treated with fixation using a hinged external fixator. All children performed passive functional exercises the day after surgery. Results: Of the 21 children, only one had recurrent severe stiffness of the elbow joint after surgery; nevertheless, the function was still improved compared with that before surgery. Complications, such as ulnar nerve symptoms, recurrent heterotopic ossification, or premature closure of the epiphyseal plate, were not observed. The mean postoperative follow-up period was 35.6 ± 17.7 (range, 10–65) months. Preoperatively, the mean elbow extension and flexion angles were 72.2° ± 12.7° and 93.6° ± 11.1°, respectively, and the range of motion (ROM) of the elbow joint was 17.8° ± 8.3°. At the final follow-up, the mean elbow extension and flexion angles were 22.7° ± 18.6° and 118.8° ± 15.4°, respectively, and the elbow joint ROM was 96.1° ± 17.4°. The differences in the preoperative and postoperative ROMs, flexion angles, and extension angles of the elbow joint were significant (p < 0.01). Meanwhile, the rotational ROM of the elbow joint was 144.7° ± 19.3° before surgery and 147.9° ± 20.1° at the final follow-up; the difference between them was not significant (p > 0.05). The Mayo Elbow Performance Score at the final follow-up was 78.57 ± 14.24, which was significantly higher than that in the preoperative period (29.76 ± 10.89), and the excellent rate was 81%. Conclusion: The aim of the surgical treatment of chronic elbow dislocation in children with extremely severe stiffness was to restore the normal anatomical relationship and to reestablish the stability of the elbow joint. Open arthrolysis and open reduction and internal fixation of the elbow joint are effective in treating chronic elbow dislocation with extremely severe stiffness in children.