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Scientific article| Volume 35, ISSUE 1, P84-91, January 2010

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Serial Casting and Splinting of Elbow Contractures in Children With Obstetric Brachial Plexus Palsy

  • Emily S. Ho
    Correspondence
    Corresponding author: Emily S. Ho, MEd, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8
    Affiliations
    The Hospital for Sick Children, Department of Rehabilitation Services, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; and The Hospital for Sick Children, Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Trisha Roy
    Affiliations
    The Hospital for Sick Children, Department of Rehabilitation Services, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; and The Hospital for Sick Children, Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Derek Stephens
    Affiliations
    The Hospital for Sick Children, Department of Rehabilitation Services, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; and The Hospital for Sick Children, Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
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  • Howard M. Clarke
    Affiliations
    The Hospital for Sick Children, Department of Rehabilitation Services, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada; and The Hospital for Sick Children, Department of Surgery, Division of Plastic Surgery, University of Toronto, Toronto, Ontario, Canada
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Published:December 04, 2009DOI:https://doi.org/10.1016/j.jhsa.2009.09.014

      Purpose

      Elbow flexion contractures are a common sequela in obstetric brachial plexus palsy. The etiology and best management of these contractures is unclear. Nonsurgical treatment involving serial casting and splinting is supported in the literature. The purpose of this study is to evaluate the effectiveness of serial casting and splinting of elbow flexion contractures in children with obstetric brachial plexus palsy.

      Methods

      A retrospective review of children with obstetric brachial plexus palsy who participated in serial casting and splinting for an elbow flexion contracture was conducted. Elbow extension passive range of motion measurements at initial, best-achieved, and final outcome were compared.

      Results

      Nineteen patients, aged 2 to 16 years, were studied. Elbow passive range of motion improved from initial to best-achieved and final outcome measurements. Fifty-three percent of patients were noncompliant between the time of best-achieved and final outcome. Loss of passive range of motion during the noncompliant period was statistically significant. Compliant patients had better treatment results. A clinical decision tree for elbow contractures in obstetric brachial plexus palsy was formulated.

      Conclusions

      Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy is effective. Successful maintenance of treatment effects is dependent on patient age and compliance.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

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