Surgical Management of Flexion Contracture

Indications for Surgery

• The American College of Cardiology and the American Heart Association recommend surgical intervention for severe flexion contractures causing significant pain, functional impairment, or failure of conservative therapy, with the choice of procedure depending on the location and severity of the contracture 1, 2
• Patients with uncorrectable flexion contractures should be evaluated for primary amputation, especially if accompanied by significant necrosis, paresis, ischemic pain, sepsis, or limited life expectancy due to comorbidities 1, 2

Surgical Procedures

• The American Stroke Association recommends surgical release of the brachialis, brachioradialis, and biceps muscles as a rational option for substantial elbow flexion contractures with pain and limited range of motion 3
• For severe thumb base osteoarthritis, the European League Against Rheumatism recommends interposition arthroplasty, osteotomy, or arthrodesis as effective therapies, considering trapeziectomy alone as equally effective as combined procedures for pain relief and functional improvement, but with fewer complications 4

Preoperative Evaluation

• The American College of Cardiology recommends evaluating the severity of contracture and indications for surgery, considering amputation for uncorrectable contractures with significant symptoms or comorbidities 1, 2

Postoperative Management

• The American Heart Association recommends a holistic approach, considering psychological and socioeconomic factors that may influence outcomes, and emphasizing the importance of maximal conservative therapy before surgery, including stretching, serial casting, and spasticity management 3, 5, 6