Range of Motion and Complications after Postburn Heterotopic Bone Excision about the Elbow

Abstract

Surgery for both limited range of motion as well as ulnar nerve compression is effective in cases of heterotopic ossification about the elbows of burned patients. Early operative intervention is indicated in progressive disease, particularly ulnar nerve palsy, if soft-tissue quality is adequate. Complications with 25% of elbows suggest that use of olecranon osteotomy for joint access may warrant review.

Resection of Heterotopic Ossification of the Elbow: A Comparison of Ankylosis and Partial Restriction

“…Djurickovic and colleagues reported poor results in the 3 patients with burn contractures who had complete ankylosis. 3 Ring and Jupiter reported a final average arc of elbow flexion and extension of 81°for 7 patients with burn-related complete bony ankylosis and 94°for 9 patients with trauma-related complete ankylosis. 4 Most series describe the surgical release of contractures of mixed etiologies, with improvements in the arc of flexion and extension of approximately 45°to 60°-comparable to the results in our series.…”

“…The following inclusion criteria were applied: (1) skeletal maturity, (2) posttraumatic or post-burn contracture, (3) arc of elbow flexion and extension less than 100°, (4) no prior contracture release, (5) no active infection, (6) no diagnosed nonunion of the supracondylar humerus or proximal ulna at the time of HO excision (nonunion of the medial epicondyle was acceptable), and (7) no advanced articular injury or arthritis.…”

“…1,2 It is not clear that this holds true in cases of complete ulnohumeral ankylosis from heterotopic bone-a particularly complex subset of patients with HO. 3,4 The complete absence of joint motion might be harmful to the articular cartilage, and the surgery is more complex, with greater difficulty finding the limitations of heterotopic and native bone, frequent ossification of the medial collateral ligament, and occasional entrapment of the ulnar nerve in bone. 3,4 We tested the null hypothesis that, controlling for other factors, patients with complete bony ankylosis and patients with HO causing partial limitation of motion have similar motion after elbow contracture release.…”

Treatment of heterotopic ossification of the elbow following burn injury: Recommendations for surgical excision and perioperative prophylaxis using radiation therapy

“…Prevention of HO recurrence is controversial and the literature in the burn population is limited. 2,5,9,12,15,19,21 To our knowledge, there have been no reports on the use of perioperative radiation therapy, in an attempt to prevent recurrence of patients with HO of the elbow after burn injury. In our study, 10 of our 11 elbows received perioperative radiation therapy.…”

Free radical scavengers versus methylprednisolone in the prevention of experimentally induced heterotopic ossification

“…Obviously, these findings cannot yet be extrapolated to humans, but they should provide a stimulus to initiate clinical studies on these prophylactic options, because surgical excision of heterotopic bone is a hazardous procedure. 1,[15][16][17] The NSAIDs routinely used for the prevention of HO (e.g., indomethacin and other compounds) have major systemic side effects and increase the risk of nonunion following open reduction and internal fixation of acetabular fractures. 9 They can also be responsible for endoprosthetic loosening.…”