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Abstract

Introduction: Heterotopic ossification has been regarded with trepidation and considered a poor prognostic factor for operative restoration of elbow motion. We compared the results of elbow contracture release in patients with and without heterotopic ossification blocking elbow motion to test the hypothesis that heterotopic bone is associated with diminished elbow motion after release. Methods: Nineteen patients with heterotopic bone restricting elbow motion (but not complete bony ankylosis) were compared with twenty-two patients with capsular contracture alone. The sex, age, initial injuries, percentage of dominant limbs, number of prior procedures, mechanisms of injury, open injuries, polytrauma patients were comparable between groups. The average pre-operative arc of flexion and extension in the patients with heterotopic bone was 52 degrees (range, 5 to 90 degrees) and 52 degrees (range, 10 to 90 degrees) in patients with capsular contracture alone. Results: After the index procedure, the flexion-extension arc in patients with heterotopic ossification averaged 105 (range, 45 to 105 degrees) and the arc in the capsular release group averaged 86 degrees (range, 0 to 135 degrees). The average improvement in F-E arc was 53 degrees (range, −20 to 107 degrees) for the HO patients and 34 degrees in the capsular release group (range, −20 to 75 degrees). The difference in improvement after the first release was significant (p = 0.034). Six of 22 patients (26%) in the capsular release group and two of eighteen patients (12%) in the HO group had a second procedure for capsular release. At an average of 24 months follow-up (range, 6 to 63 months), the final arc of flexion and extension averaged 105 degrees in the patients with heterotopic bone (range 40 to 145 degrees) and 96 degrees (range, 45 to 135 degrees) in patients without HO. The average improvement in flexion-extension arc was 53 degrees (range, −20 to 107 degrees) in the HO group and 43 degrees (range, −15 to 80 degrees) in the capsular contracture group. The greater improvement in final range of motion in patients with heterotopic ossification compared to patients with capsular contracture alone was not significant with the numbers available (p = 0.122). Conclusion: Heterotopic bone restricting motion, but not causing total ankylosis, is associated with more predictable and slightly better restoration of motion after elbow contracture release. If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use). If noted, the author indicates something of value received. The codes are identified as follows: a, research or institutional support; b, miscellaneous funding; c, royalties; d, stock options; e, consultant or employee. *The Food and Drug Administration has not cleared the drug and/or medical device for the use described in this presentation (ie, the drug or medical device is being discussed for an “off-label” use).