Natural History of the Elbow Bony Architecture in Patients With Obstetric Brachial Plexus Injury and the Association With Flexion Contractures

Purpose: The purposes of this study were to evaluate the radiographic anatomy of the elbow and try to determine its possible relation to elbow flexion contracture in patients with obstetric brachial plexus injury (OBPI). Methods: All patients with a history of OBPI with elbow flexion contracture who were evaluated clinically and radiographically were included in the study. A review was performed to include serial elbow examinations and previous treatment. Radiographs of the elbow were examined for the presence of bony abnormalities as a potential cause of elbow flexion contracture or the presence of progressive arthritic changes over time. Results: Fifty-nine patients with a history of OBPI with elbow flexion contracture were included in the study. Of them, 53 had normal bony architecture, 2 had mild radial head subluxation, and 4 had chronic anterior radial head dislocations. At a mean age at final clinical follow-up of 21 years (range, 7 to 83 years), only 7% of patients had pain localized to their elbow. There were only three patients with elbow arthritis, including two of the four with radial head dislocations. Conclusions: In the absence of a radial head dislocation, most elbow joints do not seem to undergo abnormal anatomic bony changes in patients with OBPI and flexion contractures.