Archives of Public Health

Vol. 15 No. 1 (2023): Arch Pub Health
Clinical Science

Physical treatment of posttraumatic elbow contractures in children – our experience

Online First pdf 84-94
  • Marija Gocevska,
  • Erieta Nikolikj Dimitrova,
  • Valentina Koevska,
  • Biljana Mitrevska,
  • Cvetanka Gjerakaroska Savevska,
  • Biljana Kalchovska,
  • Maja Manoleva,
  • Lazar Todorovic
Marija Gocevska
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Erieta Nikolikj Dimitrova
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Valentina Koevska
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Biljana Mitrevska
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Cvetanka Gjerakaroska Savevska
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Biljana Kalchovska
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Maja Manoleva
University Clinic for Physical Medicine and Rehabilitation; Ss. Cyril and Methodius University in Skopje, Faculty of Medicine, Republic of North Macedonia
Lazar Todorovic
University Clinic of Pediatric Surgery; Ss. Cyril and Methodius University in Skopje Faculty of Medicine, Republic of North Macedonia
DOI: https://doi.org/10.3889/aph.2023.6074

Published 2022-03-10

Keywords

  • rehabilitation,
  • contracture,
  • elbow,
  • children,
  • fracture

How to Cite

1.
Gocevska M, Nikolikj Dimitrova E, Koevska V, Mitrevska B, Gjerakaroska Savevska C, Kalchovska B, Manoleva M, Todorovic L. Physical treatment of posttraumatic elbow contractures in children – our experience. Arch Pub Health [Internet]. 2022 Mar. 10 [cited 2024 Apr. 18];15(1):84-9. Available from: https://www.id-press.eu/aph/article/view/6074

Copyright (c) 2023 Marija Gocevska, Erieta Nikolikj Dimitrova, Valentina Koevska, Biljana Mitrevska, Cvetanka Gjerakaroska Savevska, Biljana Kalchovska, Maja Manoleva, Lazar Todorovic

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

The most common complications of elbow trauma are contractures and neurovascular injuries. The complications can be a result of the initial injury, but they can also be a result of a surgical treatment. In addition to orthopedic treatment of elbow fractures, physical therapy and rehabilitation play a significant role in treatment of posttraumatic contractures. To determine the effects of physical therapy and rehabilitation of posttraumatic elbow contractures in children. This was a retrospective cross-sectional study conducted in the University Clinic for Physical Medicine and Rehabilitation, Skopje in the period 01.01.2021 – 01.07.2022. A total of 52 children were included, at the age between 2 and 13 years who had a posttraumatic elbow contracture, limited range of motion, pain and/or limitations in accomplishing daily activities. Depending on the clinical finding, children underwent a relevant physical therapy (kinesitherapy, functional therapy, electrotherapy, thermotherapy, hydrotherapy and magnetotherapy) in duration of three weeks. For assessing the effects of the rehabilitation therapy, the range of motion of the elbow and forearm was examined along with the Flynn’s scale in all children, prior to and after completion of the physical treatment. Applied physical treatment resulted in a significant improvement in all analyzed movements such as: elbow flexion (p=0.00001), elbow extension (p=0.00001), forearm pronation (p=0.00001), forearm supination (p=0.0000) and Flynn’s scale (p=0.0000). After completion of the rehabilitation treatment, excellent results were registered in 41 (85%) children, moderate in 10 (19.23%) and favorable in 1 (1.92%). Timely and adequate application of physical therapy and rehabilitation can significantly improve the final outcome in treatment of posttraumatic elbow contractures in children. A combination of different physical procedures adequately applied and personalized can significantly improve the range of motion of the elbow.

 

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References

  1. . Houshian S, Mehdi B, Larsen MS. The epidemiologyof elbow fracture in children: Analysis of 355 fractures, with special reference to supracondylar humerus fractures. J OrthopSci 2001;6:312-5. DOI: https://doi.org/10.1007/s007760100024
  2. Kuhn MA, Ross G. Acute elbow dislocations. Orthop Clin North Am 2008;39:155–61 DOI: https://doi.org/10.1016/j.ocl.2007.12.004
  3. Ogden JA. The humerus, in Skeletal Injury in the Child. New York: Springer-Verlag, 2000: 456-541. DOI: https://doi.org/10.1007/0-387-21854-8_14
  4. Emery KH, Zingula SN, Anton CG, et al. Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol 2016;46:61–6 DOI: https://doi.org/10.1007/s00247-015-3439-0
  5. Hildebrand KA. Posttraumatic elbow joint contractures: defining pathologic capsular mechanisms and potential future treatment paradigms. J Hand Surg Am 2013; 38:2227–2233 DOI: https://doi.org/10.1016/j.jhsa.2013.07.031
  6. Sun C, Zhou X, Yao C, et al. The timing of open surgical release of post-traumatic elbow stiffness: a systematic review. Medicine 2017;96:e9121 DOI: https://doi.org/10.1097/MD.0000000000009121
  7. Piper SL, Lattanza LL, Shen TS, et al. Open surgical release of posttraumatic elbow contracture in children and adolescents. J Pediatr Orthop 2017;39:241–246 DOI: https://doi.org/10.1097/BPO.0000000000000923
  8. Muchow RD, Riccio AI, Garg S, Ho CA, Wimberly RL. Neurological and vascular injury associated with supracondylar humerus fractures and ipsilateral forearm fractures in children. J Pediatr Orthop 2015;35(2):121-125 DOI: https://doi.org/10.1097/BPO.0000000000000230
  9. Howard A, Mulpuri K, Abel MF, et al. The treatment of pediatric supracondylar humerus fractures. J Am Acad Orthop Surg 2012;20(5):320-327 DOI: https://doi.org/10.5435/JAAOS-20-05-320
  10. Flynn J.C, Mathews J.G, Benoit R.L. Blind pinning of displaced supracondylar fractures of the humerus in children. Sixteen year’sexperience with long-term follow-up. J. Bone & Joint Surg. 1974;56A:263–272. DOI: https://doi.org/10.2106/00004623-197456020-00004
  11. Bernthal NM, Hoshino CM, Dichter D, Wong M, Silva M. Recovery of elbow motion following pediatric lateral condylar fractures of the humerus. J Bone Joint Surg Am 2011;93:871-7 DOI: https://doi.org/10.2106/JBJS.J.00935
  12. Muller AM, Sadoghi P, Lucas R, Audige L, Delaney R, Klein M, et al. Effectiveness of bracing in the treatment of nonosseous restriction of elbow mobility: a systematic review and meta-analysis of 13 studies. J Shoulder Elbow Surg 2013; 22:1146–1152 DOI: https://doi.org/10.1016/j.jse.2013.04.003
  13. Della-Giustina K, Della-Giustina DA. Emergency department evaluation and treatment of pediatric orthopedic injuries. Emerg Clin North Am 1999;17:895-922. DOI: https://doi.org/10.1016/S0733-8627(05)70103-6
  14. Lins RE, Simovitch RW, Waters PM: Elbow trauma and reconstruction: Pediatric elbow trauma. OrthopClin North Am 1999;30:119-32. DOI: https://doi.org/10.1016/S0030-5898(05)70066-3
  15. Norton C, Rolfe K, Morris S, Evans R, James R, Jones MD et al. Head injury and limb fracture in modern playgrounds. Arch Dis Child 2004;89(2):152-153 DOI: https://doi.org/10.1136/adc.2002.024364
  16. Marjanović Z, Nikolić P, Đorđević MN, Milićević R. Estimation of the value of skeletal extension applied in the treatment of dislocated supracondylar fractures of the humerus in children. Acta Orthop Iugosl 1999;30:125-131
  17. Myden C, Hildebrand K. Elbow joint contracture after traumatic injury. J Shoulder Elbow Surg 2011; 20:39–44 DOI: https://doi.org/10.1016/j.jse.2010.07.013
  18. Keppler P, Salem K, Schwarting B, Kinzl L. The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children. J Pediatr Orthop 2005; 25: 314-316. DOI: https://doi.org/10.1097/01.bpo.0000153879.05314.d8
  19. Spencer HT, Wong M, Fong YJ, Penman A, Silva M. Prospective longitudinal evaluation of elbow motion following pediatric supracondylar humeral fractures. J Bone Joint Surg Am 2010; 92: 904-910 DOI: https://doi.org/10.2106/JBJS.I.00736
  20. Wang YL, Chang WN, Hsu CJ et al. The recovery of elbow range of motion after treatment of supracondylar and lateral condylar fractures of the distal humerus in children. J Orthop Trauma 2009; 23: 120-125. DOI: https://doi.org/10.1097/BOT.0b013e318193c2f3
  21. Zionts LE, Woodson CJ, Manjra N, Zalavras C. Time of return of elbow motion after percutaneous pinning of pediatric supracondylar humerus fractures. Clin Orthop Relat Res 2009; 467: 2007-2010. DOI: https://doi.org/10.1007/s11999-009-0724-y
  22. Divjakovic M, Mikov A, Gajdobranski Dj, Pilipovic M. Effect of physical therapy on treatment of contactures of elbow after supracondylar humerus fractures in children. Medicina danas 2009; 8: 39.
  23. Lee S, Park MS, Chung CY et al. Consensus and different perspectives on treatment of supracondylar fractures of the humerus in children. Clin Orthop Surg 2012; 4: 91- 97. DOI: https://doi.org/10.4055/cios.2012.4.1.91
  24. Gregory A. S, Suzan M, Laina D. M, Viviana B. Lack of Benefit of Physical Therapy on Function Following Supracondylar Humeral Fracture. J Bone Joint Surg Am. 2014 Jun 4; 96(11): 944–950. DOI: https://doi.org/10.2106/JBJS.L.01696
  25. Topping RE, Blanco JS, Davis TJ. Clinical evaluation of crossed-pin versus lateral-pin fixation in displaced supracondylar humerus fractures. J Pediatr Orthop 1995; 15: 435-439 DOI: https://doi.org/10.1097/01241398-199507000-00004
  26. Wilkins KE. Residuals of elbow trauma in children. Orthop Clin North Am 1990;21(2):291-314 DOI: https://doi.org/10.1016/S0030-5898(20)31546-7
  27. Lyons ST, Quinn M, Stanitski CL. Neurovascular injuries in type III humeral supracondylar fractures in children. Clin Orthop 2000;376:62-7. DOI: https://doi.org/10.1097/00003086-200007000-00010
  28. Campbell CC, Waters PM, Emans JB, et al. Neurovascular injury and displacement in type III supracondylar humerus fractures. J Pediatr Orthop 1995; 15: 440-3. DOI: https://doi.org/10.1097/01241398-199501000-00011
  29. Brown IC, Zinar DM: Iatrogenic neurological complications after supracondylar humerus fractures in children. J Pediatr Orthop 1995;15:440-3. DOI: https://doi.org/10.1097/01241398-199507000-00005
  30. Munst P, Kuner EH, Beckmann M. Conservative treatment of pediatric elbow fractures. Orthopade. 1988;17(3):287-96.

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