Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy

Area of Science:

• Pediatric Orthopedics
• Neuromuscular Disorders
• Rehabilitation Medicine

Background:

• Elbow flexion contractures are a frequent complication of obstetric brachial plexus palsy.
• The optimal management strategy for these contractures remains uncertain.
• Nonsurgical interventions, including serial casting and splinting, are literature-supported options.

Purpose of the Study:

• To assess the efficacy of serial casting and splinting for elbow flexion contractures in pediatric patients with obstetric brachial plexus palsy.

Main Methods:

• A retrospective review was performed on pediatric patients diagnosed with obstetric brachial plexus palsy and treated with serial casting and splinting for elbow contractures.
• Passive range of motion for elbow extension was measured at baseline, peak improvement, and final follow-up.

Main Results:

• Nineteen patients (ages 2-16) demonstrated improved elbow passive range of motion from initial to final measurements.
• A statistically significant loss of range of motion occurred in 53% of patients who were noncompliant between peak improvement and final follow-up.
• Patient compliance and age were identified as critical factors influencing treatment outcomes, leading to the formulation of a clinical decision tree.

Conclusions:

• Serial casting and splinting represent an effective treatment for elbow contractures in obstetric brachial plexus palsy.
• Sustained treatment benefits are contingent upon patient age and adherence to the therapeutic regimen.