# Surgical treatment of post-traumatic elbow stiffness in pediatric patients: a systematic review and meta-analysis

## TL;DR

This study compares open and arthroscopic surgery for treating elbow stiffness in children after fractures, finding that open surgery improves range of motion more effectively.

## Contribution

The study provides a systematic review and meta-analysis comparing surgical approaches for post-traumatic elbow stiffness in pediatric patients.

## Key findings

- Open arthrolysis significantly improves range of motion compared to arthroscopic arthrolysis in pediatric patients with post-traumatic elbow stiffness.
- Complication rates for both open and arthroscopic arthrolysis are low and comparable in pediatric patients.
- The findings suggest open arthrolysis is more effective for severe cases, while arthroscopic techniques require further study to define optimal use.

## Abstract

Post-traumatic elbow stiffness (PTES) has been reported in up to 21% of pediatric patients following elbow fractures and can profoundly compromise a child's function, and independence. The primary surgical approaches include open and arthroscopic arthrolysis, both of which have demonstrated improvements in range of motion (ROM) and functional scores. This systematic review and meta-analysis aims to compare the effectiveness, ROM, and complication rates between open and arthroscopic release in pediatric patients with PTES.

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were utilized to conduct a systematic review and meta-analysis on surgical treatment for PTES. Comprehensive search was conducted in PubMed, Web of Science, Medline, and Scopus from their inception to May 10, 2025. A total of 3,660 records were screened, of which 11 studies were included using open or arthroscopic pediatric PTES elbow arthrolysis. Outcome variables were changes in the ROM and complication rates. Surgical techniques were grouped as arthroscopic vs. open arthrolysis.

Our findings showed that open arthrolysis resulted in greater ROM compared to arthroscopic arthrolysis (open arthrolysis (standardized mean difference: 58°, 95% confidence interval (CI): 46-69; P < .001), arthroscopic arthrolysis: (standardized mean difference: 33°, 95% CI: 26-39; P = .9)). Regarding the postoperative complications, there was no statistically significant difference between open and arthroscopic arthrolysis (open arthrolysis: [rate: 14%; 95% CI: 9%-22%], arthroscopic arthrolysis: [rate: 7%; 95% CI: 2%-25%].

Open arthrolysis significantly improves ROM in pediatric PTES, outperforming arthroscopic procedures, which showed nonsignificant gains. Complication rates were low and comparable, supporting the safety of both techniques. These findings favor open arthrolysis in severe cases and highlight the need for larger prospective studies to refine arthroscopic indications.