Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents

Abstract

Objective To evaluate the efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents. Methods We retrospectively analyzed clinical data from 49 older children (> 8 years) and adolescents with supracondylar humerus fracture who were treated with Slongo’s external fixation in our hospital from January 2016 to August 2020. Twenty-three patients received ultra-early postoperative rehabilitation (rehabilitation group) and 26 patients were not subjected to postoperative rehabilitation (control group). Time to ROM required for functional activity of daily living(ROM-ADL) in both groups was recorded postoperatively. Patients were followed up at 3 and 6 months after surgery to compare the elbow range of motion (ROM) and carrying angle (CA). Postoperative complications were assessed in both groups. Flynn scores and modified Mayo Elbow Performance Scores were also performed. Results The elbow function at 6 months after surgery was significantly better than that at 3 months in the control group (P = 0.32). Time to ROM-ADL in the rehabilitation group was significantly shorter than that of the control group (P = 0.028). The elbow function, Flynn scores, and modified Mayo scores in the rehabilitation group at 3 and 6 months after surgery were significantly better than that of the control group (P(ROM, 3 months and 6 months) = 0.012 vs 0.039; P(Flynn scores, ROM, 3 months and 6 months) = 0.028 vs 0.005; P(Flynn scores, CA, 3 months and 6 months) = 0.032 vs 0.026; P(Modified Mayo scores, 3 months and 6 months) = 0.039 vs 0.024; respectively). There were no iatrogenic injuries, secondary fracture displacements, myositis ossificans, elbow deformities, or other complications in either group. One case of nail tract infection occurred in the rehabilitation group and was cured. Conclusion Slongo’s external fixation is a safe and effective surgical treatment for supracondylar humeral fractures in children over 8 years old and adolescents. Ultra-early rehabilitation treatment for postoperative children can significantly speed up the recovery after surgery.

Efficacy of ultra-early rehabilitation on elbow function after Slongo’s external fixation for supracondylar humeral fractures in older children and adolescents

“…Golden et al [3] reported a correlation between increased BMI and reduced range of movement (ROM) of the elbow, with an expected loss of ROM of about 11° to 17° for obese children because of a soft tissue block to full flexion. Therefore, He et al [1] should have measured reduced flexion and total ROM of the un-injured arm for the obese R-group compared to the C-group but reported equal mean values instead, which would be highly unlikely considering Golden et al 's data [3].…”

“…We read with interest the recent publication by He and colleagues [1]. The authors [1] stated that the time to regain the range of movement required for functional activity of daily living (ROM-ADL: flexion = 30°-130°; forearm rotation = 100° (50° pronation, 50° supination)) [2] was significantly shorter for the rehabilitation group (R-group) than the control group (C-group), but this is contradicted by the provided data listed in the authors' first table (time to ROM-ADL: C-group = 6.65 ± 0.8 weeks; R-group = 9.74 ± 1.25 weeks).…”

“…The authors [1] stated that the time to regain the range of movement required for functional activity of daily living (ROM-ADL: flexion = 30°-130°; forearm rotation = 100° (50° pronation, 50° supination)) [2] was significantly shorter for the rehabilitation group (R-group) than the control group (C-group), but this is contradicted by the provided data listed in the authors' first table (time to ROM-ADL: C-group = 6.65 ± 0.8 weeks; R-group = 9.74 ± 1.25 weeks). In our experience, it would be highly unlikely for a patient group who achieved ROM-ADL (poor Flynn score) at a mean of 9.74 weeks to then progress within 2.26 weeks to the high number of good and excellent Flynn scores as recorded by He et al [1] at the 12 weeks assessment for the C-and R-group.…”

“…He et al [1] stated that there was no significant difference in weight and height between the two groups, not identifying the huge difference in body mass index (BMI), with the C-group having a normal mean BMI of 22.4 and the R-group being obese with a mean BMI of 30.3. Golden et al [3] reported a correlation between increased BMI and reduced range of movement (ROM) of the elbow, with an expected loss of ROM of about 11° to 17° for obese children because of a soft tissue block to full flexion.…”

“…He et al [1] did not describe how ROM was measured and did not test intra-and inter-observer reliability. The latter authors [1] reported a mean increase of the carrying angle between the 3 and 6 months assessments of 3.24° (66%) for the C-group and 3.42° (52%) for the R-group, which can only be a systematic measuring error, since such a change would not occur as a result of rehabilitation because it is a fixed angle and potential remodelling of a coronal deformity would take much longer than 3 months, if it occurs at all. Therefore, the reported differences for total elbow ROM and flexion between the C-and R-group at 3 months (3.01°/1.74°) and 6 months (3.36°/2.09°) are most likely not real differences but measuring errors.…”