Use of the elbow compass universal hinge in pediatric patients

The purpose of this study was to review the Compass Universal Hinge dynamic elbow external fixator in pediatric conditions. Eight patients with diagnoses of ulnar club hand (n = 2), proximal radial synostosis with hypoplastic coronoid (n = 1), pterygium cubitale (n = 2), and elbow arthrofibrosis (n = 3) were identified. Indications for fixator placement were to maintain elbow stability during forearm lengthening (two cases), protect a coronoid reconstruction (one case), increase range of motion via the fixator (two cases), and maintain stability and increase range of motion after open release (three cases). There were five boys and three girls with an average age at surgery of 11.5 (range 3-19) years. In each case, the goal for fixator use was achieved: both forearm lengthenings were completed without elbow instability, the coronoid reconstruction healed in good position, and four of five patients obtained increased range of motion via the fixator (average improved arc of motion of 31 degrees), with all elbows remaining reduced and stable. Complications included four pin tract infections, one of which became osteomyelitis; two broken/loose pins; and two cases of decreased elbow range of motion. Average follow-up was 29 (range 3-62) months. Use of the Compass Universal Hinge dynamic external fixator can be adapted to children and has proven useful in managing certain difficult conditions.