Surgical Treatment of Elbow Contractures in Postburn Children

One-hundred and forty-six postburn elbow contractures in children were classified into four categories--simple band, complex band (crosses shoulder and/or wrist joint), diffuse scar, and limited scar--to assess the results of surgical treatment. The best results were seen in children less than 5 years of age and in children with less than 50 percent third-degree total body surface area burns. Types of release included skin grafts, local flaps (with or without graft), and deep releases. Generally, good to excellent results were seen regardless of technique of release, and in no case was the postoperative contracture worse than the preoperative contracture. Full extension was restored in 82 percent of contractures that were less than 50 degrees and in 50 percent of contractures greater than 50 degrees. Major complications were uncommon, with 4 of 171 elbows requiring reoperation because of skin-graft or flap loss. Repeat releases were of minimal functional benefit.