Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Abstract

Background Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood. Questions/purposes We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatment-related factors associated with the development of HO severe enough to restrict motion after surgery for elbow trauma. We also determined what percentage of the variation in HO restricting motion was explained by the variables studied. Methods Between 2001 and 2007, we performed surgery on 417 adult patients for elbow fractures; of these, 284 (68%) were available for radiographs at a minimum of 4 months and clinical review at a minimum of 6 months after surgery (mean, 7.9 months; range, 6-31 months). HO was classified according to the Hastings and Graham system. Patients with HO restricting motion (defined as a Hastings and Graham Class II or III) were compared with patients without HO restricting motion in terms of demographics, fracture location, elbow dislocation, open wound, mechanism of injury, ipsilateral fracture, head trauma, time from injury to surgery, number of surgeries within 4 weeks, total number of surgeries, bone graft, and infection, using bivariate and multivariable analyses. A total of 96 patients had radiographic HO, and in 27 (10% of those available for followup), it restricted motion. Results There were no patient-related demographic factors that predicted the formation of symptomatic HO. Ulnohumeral dislocation in addition to fracture (odds ratio, 2.38; 95% CI, 1.01-5.64; p = 0.048) but not fracture location was associated with HO. Longer time from injury to definitive surgery and number of surgical procedures in the first 4 weeks were also independent predictors of HO (p = 0.01 and 0.004, respectively). These factors explained 20% of the variance in risk for HO restricting motion. Conclusions HO restricting motion after operative elbow fracture treatment associates with factors that seem related to injury complexity, in particular, ulnohumeral dislocation, delay, and number of early surgeries; however, a substantial portion of the variation among patients with elbow fracture who develop restrictive HO remains unexplained. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Comparative Study of Simple and Complex Open Elbow Dislocations

“…Nevertheless, neurovascular complications were seen mainly in simple dislocations in contrast to those found in complex dislocations. This distribution is in agreement with the literature in relation to fracture-dislocations [21][22][23]25]. However, neurovascular injury prevalence is higher in open dislocations than in closed dislocations [4].…”

The posttraumatic stiff elbow: an update

“…The newly formed ectopic bone restricts elbow motion and upper extremity function by a discrete block to motion. Several factors increase the risk of developing HO around the elbow, including central nervous system injury, burns, surgery (i.e., time to surgery and time to mobilization after surgery), and most commonly direct trauma [26][27][28][29][30].…”

Heterotopic Ossification following Total Elbow Arthroplasty in a Patient with Parkinson’s Disease: Case Report and Literature Review

“…Elbow subluxation, floating fractures, ulnohumeral dislocation, and open fractures are more likely to result in clinically relevant HO [14]. Other risk factors associated with HO after total joint arthroplasty include male sex, concurrent cranial or abdominal injury, intraarticular debris, contralateral fracture, burn injuries, CNS trauma, certain surgical approaches, and development of HO after previous arthroplasty [14]. The optimal classification for upper extremity HO is offered by Hastings and Graham (Table 1) [15,16].…”