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Anterior release of elbow flexion contractures in children with obstetrical brachial plexus lesions

Antonio García-López1, Pablo Sebastian, Francisco Martinez-López

  • 1Upper Limb Unit, Orthopaedic Department, Hospital General Universitario de Alicante, Alicante, Spain. garcialopez1@hotmail.com

The Journal of Hand Surgery
|July 4, 2012
PubMed

Insights

Anterior elbow release effectively treats severe elbow flexion contractures in obstetric brachial plexus palsy, improving extension without compromising flexion strength. This surgical method offers significant functional gains for affected patients.

Area of Science:

  • Orthopedic Surgery
  • Pediatric Orthopedics
  • Brachial Plexus Injury

Background:

  • Elbow flexion contractures are common in upper obstetric brachial plexus palsy (OBP).
  • Contractures exceeding 30° often show limited improvement with conservative treatments like serial splinting.
  • Significant contractures can lead to functional and aesthetic limitations.

Purpose of the Study:

  • To evaluate the efficacy of anterior elbow release with partial tenotomy of the brachialis and biceps muscles.
  • To assess the impact of this surgical technique on elbow flexion contractures in OBP patients.

Main Methods:

  • Ten patients with OBP (C5-C6) and elbow flexion contractures (35°-60°) underwent anterior elbow release.
  • Distal tendons of the biceps and brachialis muscles were lengthened.
  • Patients had pre-operative elbow flexion strength of 4+ (MRC scale) and no bone abnormalities.

Main Results:

  • A mean gain in elbow extension of 28° was achieved after a 3-year follow-up.
  • Elbow flexion strength was maintained in all patients.
  • Patients reported high satisfaction, with hypertrophic scarring as the main complication.

Conclusions:

  • Anterior elbow release is a valuable surgical option for elbow flexion contractures greater than 35° in OBP.
  • The procedure effectively reduces deformity, restoring functional elbow range of motion.
  • This technique does not compromise elbow flexion strength.
Abstract

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