Post-Surgery Stiffness in Pediatric Humerus Fracture: Seeking Solutions - Orthopedics

Postoperative angular stiffness of the left humerus in a pediatric patient with a lateral condyle fracture?

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Dear Doctor,
On March 13, just before turning four years old, my child accidentally fell from the bed and sustained a deformity in the left elbow due to a fracture.
That evening, we took him to the emergency room for an X-ray, which confirmed a fracture of the left humerus.
He underwent surgery that night for reduction and fixation with steel pins, and was placed in a splint for eight weeks.
We returned weekly for follow-up X-rays, which showed normal bone growth without significant issues.

On April 22, the doctor removed the steel pins, but my child developed stiffness in the elbow, unable to fully extend or flex it.
A comparison X-ray of both arms indicated a slight rotation of the bone, but the doctor assured us it would not affect functionality.
To address the stiffness, the doctor suggested a procedure under general anesthesia to manually adjust the elbow.
However, given that my child had already undergone two surgeries and was emotionally burdened, we were reluctant to proceed with another surgery so soon.
Instead, we opted for physical and occupational therapy, which the doctor agreed could be beneficial, suggesting that my child might recover in about six months.
We began therapy on May 10 and continued for two months, but there was no significant improvement; the arm remained unable to fully extend (approximately 5 degrees short) and could only flex to 90 degrees.
We sought consultations at two major children's orthopedic hospitals in Taipei.
One doctor indicated that the healing was not optimal and suggested monitoring, while another arranged for a CT scan and also noted that the healing was inadequate, impacting the flexion and extension function.
If further surgery were necessary, the doctor warned of a 30% risk of tissue necrosis, which we felt was too great a risk to take.
Ultimately, the physician advised against further rehabilitation, suggesting we let our child play and return for follow-up X-rays in three months.
We noticed that without therapy, the stiffness in our child's arm worsened, and the range of motion remained limited to 90 degrees.
For instance, when hearing loud noises like firecrackers, he could not cover his ears with that hand, and it required significant body twisting to achieve any movement.
Concerned about his condition, we learned of a martial arts center that offered gentle techniques to help relax the fascia and had previous success in treating similar cases of elbow stiffness and deformity.
We began treatment there and have attended nearly ten sessions.
Sometimes, after the instructor's manipulation, my child could extend his arm, but the flexion remained at 90 degrees.
The instructor noted that the key issue was not the bone alignment but rather the unaddressed injury to the radius during the fall, which had also resulted in dislocation.
The surgery only addressed the fractured humerus, leaving the radius untreated.
Consequently, as the bone healed, there was a slight rotation at the junction, leading to the formation of scar tissue that hindered movement.
If we consult orthopedic specialists again, they typically focus solely on the bones and may overlook other issues.
The orthopedic doctor reiterated the risks associated with another surgery, strongly advising us to consult a hand surgeon to explore minimally invasive options for addressing the suspected soft tissue problems.
Additionally, a friend recommended traditional Chinese medicine techniques, such as acupuncture and guasha, to help break down adhesions and improve the range of motion.

It has been nearly six months since the incident on March 13, and my child's left arm appears noticeably weaker, with no progress in range of motion (still unable to fully extend and flexing only to 90 degrees).
We are at a loss for how to help him.
Sincerely, a worried and helpless mother.

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Miss Du, 30~39 year old female. Ask Date: 2021/09/02