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Management of fixed flexion contracture of the elbow in haemophilia
1International Hemophilia Treatment and Training Center, Mount Sinai Hospital, New York, USA.
The authors stress that prevention of flexion contractures and artropathy by early factor replacement and physical therapy for every haemophiliac is the standard of care. Physical therapy, serial casting, and Quengel cast correction have not proven successful in correction of fixed flexion contractures at the elbow. In the patient who has a flexion contracture that interfered with function, an attempt at physical therpay combined with the use of either the Dynasplint or Flowtron will be tried. If there is no response, a surgical synovectomy combined with a possible radial head resection and anterior capsular release would be the authors' procedure of choice. In the face of advanced arthropathy, the authors would consider a distraction arthroplasty.
The authors stress that prevention of flexion contractures and artropathy by early factor replacement and physical therapy for every haemophiliac is the standard of care. Physical therapy, serial casting, and Quengel cast correction have not proven successful in correction of fixed flexion contractures at the elbow. In the patient who has a flexion contracture that interfered with function, an attempt at physical therpay combined with the use of either the Dynasplint or Flowtron will be tried. If there is no response, a surgical synovectomy combined with a possible radial head resection and anterior capsular release would be the authors' procedure of choice. In the face of advanced arthropathy, the authors would consider a distraction arthroplasty.
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