Serial casting and splinting of elbow contractures in children with obstetric brachial plexus palsy.

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.