Appropriate excision time of heterotopic ossification in elbow caused by trauma

Abstract

ObjectiveThe aim of this study was to investigate the optimal timing for the resection of heterotopic ossification (HO) of the elbow.MethodsWe retrospectively reviewed 42 patients who were treated operatively for heterotopic ossification of the elbow from March 2010 to December 2014 at our institution. The patients were divided into early (before 12 months) and late (after 12 months) excision groups. In the early excision group (17 patients), the average time from the initial injury to HO excision was 7.4 (3–11) months, and in the late excision group (25 patients), the average time was 33.5 (12–240) months. Every patient was evaluated by range of motion (ROM), the Mayo Elbow Performance Score (MEPS), postoperative complications and HO recurrence.ResultsThe preoperative mean ROM in the late excision group was greater than that of the early excision group, suggesting that the ROM is expected to increase even without surgery. Both early and late surgery increased ROM and MEPS, but early surgery improved ROM and MEPS more than late surgery did (p < .05).ConclusionsEarly excision of HO can provide better elbow function, as indicated by ROM and MEPS. Considering that there were no notable differences in postoperative ROM and MEPS, HO recurrence, or postoperative complications, we concluded that early excision is safe and that the time from an elbow injury to surgery may be shortened.Level of EvidenceLevel III, therapeutic study.

Extensive Circumferential Heterotopic Ossification Discovered at the Base of a Loop Ileostomy

“…The exact natural history of heterotopic ossification regarding onset may depend on the location. The time from initial injury to development of ossification has been reported as early as 4 weeks following burn injury and as early as 3 months following elbow injury [27, 28]. One case report suggests that the time from initial injury could be as early as days for development of HO specifically affecting the mesentery [1].…”

Determining the effective timing of an open arthrolysis for post-traumatic elbow stiffness: a retrospective cohort study

“…Traditionally, surgeons waited for at least 1 year after initial trauma to intervene surgically, due to a high risk of recurrence of HO [ 37 ]. Recent studies have however, reported good results following an early excision (at < 1 year) with no difference in the HO recurrence rates as compared to a delayed surgery [ 7 , 38 ]. Chen retrospectively reviewed 164 patients with HO, who underwent open arthrolysis, and divided them into two groups, with the HO excision performed at an average 23.0 months after initial injury (range: 9–204 months) and an early excision group, who underwent the excision procedure at average 6.1 months (range: 3–8 months).…”

Ultrasonography of Complications in Surgical Repair of the Distal Biceps Brachii Tendon

“…40 Early excision (ie, before 12 months after surgery) is recommended, especially for large ossification ( Figure F13 13). 41…”

“…Indomethacin and radiotherapy have been used in an effort to prevent heterotopic ossification . Early excision (ie, before 12 months after surgery) is recommended, especially for large ossification (Figure ) …”