Serial Casting and Hinged Elbow Bracing in the Treatment of Fixed Flexion Deformity of the Elbow Following Obstetric Brachial Plexus Palsy.

Abstract

Fixed flexion deformity (FFD) of the elbow is a recognized sequela of obstetric brachial plexus palsy (OBPP). Physiotherapy, stretching, and extension splinting are commonly used, but established contractures may persist despite these measures. This study evaluated the outcomes and complications of serial casting and hinged elbow bracing for OBPP-related elbow FFD. A retrospective case series of 89 treatment courses in 73 patients with OBPP-related elbow FFD treated between 1996 and 2014 was performed. There were 80 serial casting courses, 8 hinged elbow brace courses, and 1 combined course. Outcomes were analyzed at the treatment-course level. The primary outcome was the change in active elbow FFD measured before and after treatment. Treatment duration, number of casts, complications, premature termination, and recurrence requiring repeat treatment were recorded. The mean age at treatment was 12.2±4.9 years. Mean treatment duration was 6.2±3.7 weeks. Mean pretreatment active FFD was 45.8±19.9 degrees and improved to 20.7±15.1 degrees after treatment, giving a mean improvement of 25.2 degrees (95% CI: 21.6-28.8 degrees; P<0.001; Cohen dz=1.49). The recorded range of pretreatment FFD was 15 to 120 degrees. Fifty-eight treatment courses (65.2%) achieved a post-treatment FFD of 20 degrees or less. Eight treatment courses (9.0%) were terminated prematurely because of complications, discomfort, travel burden, or noncompliance. Sixty-two of 73 patients (84.9%) required only 1 treatment course. Recurrence requiring repeat treatment occurred in 11 patients (15.1%), who underwent 27 treatment courses in total. Serial casting and hinged elbow bracing produced clinically meaningful improvement in elbow extension in patients with OBPP-related elbow FFD, with a low rate of complications and premature termination. Most patients required only 1 treatment course. Recurrence occurred in a minority of patients, but repeat treatment remained effective, supporting these techniques as repeatable nonoperative options for selected patients. Level IV, case series, retrospective.