Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial
L S Op de Coul1, S Bleeker2, J H de Groot1
1Department of Rehabilitation, 4501Leiden University Medical Center, Leiden, Netherlands.
Insights
Dynamic orthosis and serial casting are comparable treatments for neonatal brachial plexus palsy elbow flexion contractures. Both methods effectively reduce contractures and achieve functional goals in children.
Area of Science:
- Pediatric Orthopedics
- Neuromuscular Disorders
- Rehabilitation Medicine
Background:
- Elbow flexion contractures are a common complication of neonatal brachial plexus palsy.
- Limited evidence exists for optimal treatment strategies for these contractures.
Purpose of the Study:
- To compare the effectiveness of dynamic orthosis versus serial casting for treating elbow flexion contractures in children with neonatal brachial plexus palsy.
Main Methods:
- A randomized controlled trial with one-year follow-up was conducted.
- Participants with ≥30° elbow flexion contracture received either a dynamic orthosis or serial casting followed by splinting.
- Contracture degree and goal attainment were assessed at multiple time points.
Main Results:
- Both dynamic splinting and serial casting significantly reduced elbow flexion contractures at one year.
- Serial casting showed a greater reduction in the initial 20 weeks, but this difference was not significant at one year.
- Functional goals were achieved in 80% of the dynamic splinting group and 82% of the serial casting group.
Conclusions:
- Dynamic night orthosis is a viable alternative to serial casting for managing elbow flexion contractures in this population.
- Treatment choice should be individualized in consultation with patients and parents.
Objective:
Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting.
Methods:
A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks.
Results:
55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median -8.5°, interquartile range [IQR] -13.5, -5) and serial casting (median -11.0°, IQR -16, -5) resulted in significant reduction of contracture (P < 0.001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up (P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively.
Conclusion:
The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.
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