Correction of Elbow Flexion Deformity in Patients Affected With Spasticity Through the Lateral Approach: Surgical Technique and Results

Fixed and dynamic elbow flexion deformity due to spasticity represents a common, yet challenging, clinical entity. Several surgical options have been described in literature, the majority of which utilize the anterior approach, through the antecubital fossa to release biceps. We propose a novel technique, using the lateral approach, as a safer and simpler option that allows release of the brachialis while leaving biceps intact to act as a supinator. All patients that were referred to our institution for treatment of an elbow flexion deformity due to spasticity between 2012 and 2016 were assessed. Patients with a previous history of trauma in the affected elbow or who failed to attend their follow-up appointments were excluded from the study. The lateral approach was used and all procedures were carried out by the senior author. Minimum follow-up was 12 months with a mean follow-up time of 20 months (range, 12 to 48 mo). Overall, 18 patients were assessed. One patient was excluded due to previous elbow trauma and another 3 were lost to follow-up. The rest 14 patients were included in the study. The underlying etiology was cerebral palsy in 3 patients, head injury in 5 patients, cerebrovascular accidents in 5 patients and multiple sclerosis in 1 patient. Elbow extension was significantly improved in all patient groups. Preoperative flexed elbow contracture measured 74 degrees on average (range, 10 to 150 degrees), whereas postoperatively these figures were 21 degrees on average (range, 0 to 50 degrees). No major postoperative complications were noted, including neurovascular compromise and surgical wound healing problems. On the basis of our results, we believe that the lateral approach for elbow contracture release may be safer and technically less demanding, compared with the anterior approach, while its results are comparable to the latter. Furthermore, leaving biceps intact preserves a powerful supinator to resist overactivity in the pronator muscles. Level of Evidence: Level IV—case series.