Closed Manipulation under Anesthesia for Pediatric Post-Traumatic Elbow Arthrofibrosis

Background: Post-traumatic elbow arthrofibrosis (PEA) and its associated limitations to elbow range of motion (ROM) are a recognized consequence of trauma to the pediatric elbow. Closed manipulation under anesthesia (CMUA) of the elbow can be performed in pediatric patients as a nonoperative attempt to improve dysfunctional ROM. Minimal outcome data to support CMUA exist. The study evaluates the efficacy of CMUA for PEA in pediatric patients. Methods: Patients younger than 18 years who underwent CMUA (Current Procedural Terminology code 24300) for PEA between 2005 and 2015 at 3 institutions were included. A retrospective chart review was performed to collect demographic data and ROM premanipulation and at last follow-up. Paired 2-tailed t tests were used to compare pre- and postmanipulation elbow ROM. Results: Thirteen patients with a mean age of 12.2 +/- 2.6 years (range 6.7-15.6 years) met the inclusion criteria. Median time to CMUA from initial surgery was 4.2 months (interquartile range [IQR] 3.6-8.4, range 14-19.7 months). Median follow-up time was 6 months with an IQR of 3.3-10.0 months. At last follow-up, there was significant improvement in elbow flexion of 22 degrees +/- 17 degrees (P <.001) and extension of 29 degrees +/- 21 degrees (P < .001). The average premanipulation motion arc of 60 degrees +/- 24 degrees significantly increased to 110 degrees +/- 22 degrees at final assessment (P < .001). Conclusion: CMUA appears to be a valuable alternative and reliable procedure for improving PEA in pediatric patients who exhaust nonoperative interventions. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.