Surgical treatment of elbow flexion contracture due to brachial plexus birth injury: A systematic review and meta-analysis.

Background: This study aimed to evaluate the effectiveness of surgical treatments for elbow flexion contracture in patients with brachial plexus birth injury (BPBI), as well as to assess postoperative complications-specifically, loss of elbow flexion-associated with these interventions. A systematic review and meta-analysis were conducted to compare pre- and postoperative outcomes across different surgical techniques.

Methods: A systematic search was performed in PubMed, Scopus, and Embase. Eight case series were included, reporting on anterior release, olecranon resection, biceps tendon lengthening, and gradual arthrodiastasis. Mean differences in elbow extension gain and 95% confidence intervals (CIs) were calculated. Subgroup analyses considered follow-up duration and age at surgery.

Results: Out of 2700 initially screened articles, eight were included. The mean gain in elbow extension was 29.69° (CI: 23.69-35.53, p < .00001). Gradual arthrodiastasis achieved the highest improvement (47.00°, CI: 37.08-56.92), followed by anterior release (30.36°, CI: 26.56-34.16). Subgroup analysis showed better outcomes in the 12-36 month follow-up group (29.83°, CI: 22.66-37.01). Furthermore, patients over 18 years of age showed the greatest improvement (47.00°, CI: 37.08-59.92); however, this result is based solely on a single study that utilized gradual arthrodiastasis, thereby limiting its generalizability .No significant loss of elbow flexion was observed.

Discussion: Surgical interventions significantly improve elbow extension in BPBI patients. Gradual arthrodiastasis is the most effective, though variability in techniques limits direct comparison. Standardized protocols and long-term prospective studies are needed.