Affiliations: [a] Departments of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands | [b] Department of Rehabilitation, Leiden University Medical Center, Leiden, The Netherlands
Correspondence:
[*]
Corresponding author: R.G.H. H. Nelissen, Department of Orthopaedics, Leiden University Medical Center, J-11-S, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Tel.: +31 (0)71 5263606; Fax: +31 (0)71 5266743; E-mail:r.g.h.h.nelissen@lumc.nl
Abstract: PURPOSE: The objective of this study was to evaluate the
effectiveness of serial casting of elbow flexion contractures in neonatal
brachial plexus palsy. METHODS: A prospective consecutive cohort study was performed with
a median follow-up of 5 years. Forty-one patients with elbow flexion
contractures ≥ 30° were treated with serial casting until the
contracture was ≤ 10°, for a maximum of 8 weeks. Range of motion,
number of recurrences and patient satisfaction were recorded and analyzed
using Wilcoxon signed-rank and Cox regression tests. RESULTS: Passive extension increased from a median of -40° (IQR
-50 to -30) to -15° (IQR -10 to -20, p < 0.001). Twenty patients showed 37
recurrences. The baseline severity of passive elbow extension had a hazard
ratio of 0.93 (95% CI 0.89 to 0.96, p < 0.001) for first recurrence. Median
patient satisfaction was moderate. Four patients showed loss of flexion
mobility and in two patients serial casting had to be prematurely replaced
by night splinting due to complaints. CONCLUSION: Serial casting improved elbow flexion contractures,
although recurrences were frequent. The severity of elbow flexion
contracture is a predictor of recurrence. We recommend more research on
muscle degeneration and determinants involved in elbow flexion contractures
to improve treatment strategies and prevent side-effects.
Keywords: Muscles, contracture, elbow, brachial plexus, serial casting
