Surgical treatment of post-traumatic elbow stiffness in pediatric patients: a systematic review and meta-analysis

Post-traumatic elbow stiffness (PTES) has been reported in up to 21% of pediatric patients following elbow fractures and can profoundly compromise a child's function, and independence. The primary surgical approaches include open and arthroscopic arthrolysis, both of which have demonstrated improvements in range of motion (ROM) and functional scores. This systematic review and meta-analysis aims to compare the effectiveness, ROM, and complication rates between open and arthroscopic release in pediatric patients with PTES.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Science, Medline, and Scopus from their inception to May 10, 2025. A total of 3,660 records were screened, of which 11 studies were included using open or arthroscopic pediatric PTES elbow arthrolysis. Outcome variables were changes in the ROM and complication rates. Surgical techniques were grouped as arthroscopic vs. open arthrolysis.

Our findings showed that open arthrolysis resulted in greater ROM compared to arthroscopic arthrolysis (open arthrolysis (standardized mean difference: 58°, 95% confidence interval (CI): 46-69; P < .001), arthroscopic arthrolysis: (standardized mean difference: 33°, 95% CI: 26-39; P = .9)). Regarding the postoperative complications, there was no statistically significant difference between open and arthroscopic arthrolysis (open arthrolysis: [rate: 14%; 95% CI: 9%-22%], arthroscopic arthrolysis: [rate: 7%; 95% CI: 2%-25%].

Open arthrolysis significantly improves ROM in pediatric PTES, outperforming arthroscopic procedures, which showed nonsignificant gains. Complication rates were low and comparable, supporting the safety of both techniques. These findings favor open arthrolysis in severe cases and highlight the need for larger prospective studies to refine arthroscopic indications.