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Anatomy and Natural History of the Elbow Joint in Obstetric Brachial Plexus Injuries
Eric Wagner, MD; J.D. Werthel, MD; Bassem T. Elhassan, MD
Orthopaedic Surgery, Divison of Hand Surgery, Mayo Clinic, Rochester, MN

Purpose: To date, there is a paucity of information within the published literature on the radiographic anatomy of the elbow, its long-term progressive changes and its relationship to elbow flexion contracture in patients with obstetric brachial plexus injuries (OBPI). The purpose of this study is to evaluate the radiographic anatomy of the elbow and its relation to elbow flexion contracture in patients with OBPI, as well as the natural history of the progressive radiographic changes of the elbow.

Methods: We examined all patients at our institution with OBPI who had radiographic evaluation of the elbow for a history of elbow flexion contracture. All patients had to have a recent radiograph as we aimed to determine whether bony abnormalities were underlying flexion contractures in OBPI patients. Radiographic evaluation was performed to determine the presence of bony abnormalities of the elbow and the presence of progressive arthritic changes over time. In addition, a detailed medical review was performed focusing on elbow range of motion and function, and past surgical interventions for elbow contracture.

Results: We identified 59 patients who fit our inclusion criteria. There were 35 (59%) females, with 33 (55%) of the injuries involving the right extremity. Every patient used their un-injured extremity as their dominant extremity. At an average clinical follow-up of 24 years (8-75), the average elbow range of motion was 32o-122o (total arc of 90o). All patients were treated with therapy and splinting for their elbow flexion contracture at some point in their lives, while 12 patients underwent attempt at surgical release. Although 62% of patients reported pain in their affected extremities, only 7% patients localized the pain to their elbow. Three patients had pathologies involving their ipsilateral elbows, including 2 radial head dislocations and 1 patient with ulnar nerve compression at the elbow. At an average follow-up of 16.5 (4-75) years, only 3 (5%) patients had radiographic evidence of moderate or severe elbow arthritis. 2 of these patients had congenital anterior radial head dislocations, while the other patient had an 85o flexion contracture and progressive elbow arthritis.

Summary Points: Patients with OBPI experience a high rate of flexion contractures. However, only 5% of patients with flexion contractures develop arthritis. This study adds an important to consideration for surgeons as they evaluate the need for bony procedures when treating flexion contractures for patients with OBPI.

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