Functional Improvement after Posterior Elbow Releases in Arthrogrypotic Children

Fąfara A1,2*, Kowalczyk B1 and Kuźnik-Buziewicz A1

1Arthrogryposis Treatment Centre, University Children’s Hospital, Krakow, Poland
2Institute of Physiotherapy, Jagiellonian University Medical College, Krakow, Poland

^*Correspondance to: Alicja Fąfara 

 PDF  Full Text DOI: 10.25107/2474-1647.3604

Abstract

Study design: A retrospective case series study. Background: Arthrogryposis Multiplex Congenita (AMC), is a heterogeneous condition defined as multiple congenital joint contractures in two or more body areas. Upper limb contractures in arthrogrypotic patients restricts their activity. The loss of elbow flexion makes self-feeding and selfcare impossible. Posterior elbow release allows the patient to become more independent in daily living. Objectives: This retrospective case series study aimed to measure improvements in self-care independence following posterior elbow release in 11 children with arthrogryposis. Methods: Eleven patients aged 4.1 years on average at the time of surgery (range: 2 to 12 years), underwent posterior elbow capsulotomy and triceps VY lengthening due to stiff extension contractures. Two subjects underwent surgery on both upper limbs. All the patients underwent uniform postoperative physical therapy and were provided with individual orthotics in our institution. All subjects were reexamined 12 months after surgery. They underwent a final follow-up examination after ≥ 3 years or more (3.5 on average). The final examination included assessment of elbow passive range of motion, presence of adaptive maneuvers, functional outcomes, and patient/parent satisfaction using the Pediatric Outcome Data Collection Instrument (PODCI) and International Classification of Functioning (ICF). Results: Nine children achieved passive elbow flexion of at least 90 degrees. One child required repeated release to increase functional flexion. One child achieved unsatisfactory results with 70° of flexion. In seven children, 10° to 40° of flexion contracture occurred. All but one child was able to reach their mouth using passive assistance. Functional assessment revealed improvement in the upper limb PODCI and ICF domains in 9 of 11 children, especially the possibility of using a fork and putting on a coat. Conclusion: Posterior elbow release extended the elbow arc of motion, improving hand-to-mouth action for independent feeding and self-care. Improvements were noted in the upper-limb PODCI and ICF domains.

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Cite the article

Fąfara A, Kowalczyk B, Kuźnik- Buziewicz A. Functional Improvement after Posterior Elbow Releases in Arthrogrypotic Children. Clin Surg. 2022; 7: 3604.