Heterotopic ossification after surgery for distal humeral fractures

Abstract

We retrospectively reviewed 89 consecutive patients (45 men and 44 women) with a mean age at the time of injury of 58 years (18 to 97) who had undergone external fixation after sustaining a unilateral fracture of the distal humerus. Our objectives were to determine the incidence of heterotopic ossification (HO); identify risk factors associated with the development of HO; and characterise the location, severity and resultant functional impairment attributable to the presence of HO. HO was identified in 37 elbows (42%), mostly around the humerus and along the course of the medial collateral ligament. HO was hazy immature in five elbows (13.5%), mature discrete in 20 (54%), extensive mature in 10 (27%), and complete bone bridges were present in two elbows (5.5%). Mild functional impairment occurred in eight patients, moderate in 27 and severe in two. HO was associated with less extension (p = 0.032) and less overall flexion-to-extension movement (p = 0.022); the flexion-to-extension arc was < 100º in 21 elbows (57%) with HO compared with 18 elbows (35%) without HO (p = 0.03). HO was removed surgically in seven elbows. The development of HO was significantly associated with sustaining a head injury (p = 0.015), delayed internal fixation (p = 0.027), the method of fracture fixation (p = 0.039) and the use of bone graft or substitute (p = 0.02).HO continues to be a substantial complication after internal fixation for distal humerus fractures.

Heterotopic Ossification: Basic-Science Principles and Clinical Correlates

“…The prevalence of heterotopic ossification after an elbow fracture is also approximately 40%, and it is most commonly located posteromedially 41,42 . More than 20% of those who develop heterotopic ossification in this setting have clinically relevant motion deficits in the form of a decreased arc of flexion-extension to <100°.…”

“…More severe heterotopic ossification was associated with a concomitant distal humeral fracture, triad injury, Monteggia fracture-dislocation, and transolecranon fracture-dislocation. Given that a delay in intervention increases the risk for heterotopic ossification, prompt operative fixation is imperative 42 . Prophylaxis should be considered in patients at high risk for heterotopic ossification, and treatment is focused on surgical excision 39,43,44 .…”

A survey of proteomic biomarkers for heterotopic ossification in blood serum

“…In civilian populations, HO may occur after a traumatic event, including hip arthroplasty, distal humerus fractures, spinal cord injuries (SCI), and closed brain injuries [6]. The etiology of HO remains unknown, but clinical risk factors include trauma, amputation, traumatic brain injury (TBI), SCI, thermal injury, major hip arthroplasty, and other major orthopedic surgery [7].…”

Incidence of and risk factors for the development of asymptomatic heterotopic ossification after elbow fracture fixation

“…6 The method of fracture fixation is also a risk factor for the development of ectopic bone after surgery for distal humeral fractures. 8 In the current study, we examined the incidence of and risk factors for asymptomatic HO after ORIF of elbow fractures. Three significant risk factors were identified: underlying diseases, fracture dislocation, and prolonged operative time.…”