346 Elbow Contracture Severity at Hospital Discharge in Patients with Heterotopic Ossification

Abstract

Heterotopic ossification (HO), the development of abnormal bone in soft tissue, is an uncommon but significant complication of burn injury. HO most often affects the elbow joint and is associated with reduced range of motion (ROM), pain, and disability. The purpose of this study is to evaluate the association between the presence of HO and severity of elbow contractures. Data was obtained from the Burn Model System National Database. Contracture data was recorded between 1994 and 2003. All patients over 18 years with an elbow contracture at acute discharge were included. Elbow ROM was compared for those with and without radiological evidence of HO. Contracture severity was reported as both mean absolute loss of ROM in degrees and relative percent loss of normal ROM. Elbow ROM was further stratified by total body surface area (TBSA) subgroups (<20, 20–40, >40%) and comparisons were made between the HO and non-HO groups using two-sample t-tests. A p-value of < 0.05 was considered statistically significant. The database included 207 patients (22 with HO, 185 without HO) with 407 instances of elbow contracture. The population was 85.5% male, had a mean (SD) age of 40.2 (14.4) years, and a mean (SD) burn size of 30.1 (19.0)% total body surface area. Elbow contractures in those with HO demonstrated worse elbow flexion compared to those without HO in the whole population (mean absolute loss: 50 vs. 30 degrees, p < 0.0001). Significantly worse elbow flexion outcomes were also noted in the 20–40% TBSA group (62 vs. 28 degrees, p = 0.0003). There were no significant differences between groups (unstratified and stratified by TBSA) in elbow extension. (Table) HO is associated with worse elbow ROM for burn survivors. This study improves our understanding of the impact of HO on elbow contracture severity and association with elbow flexion contractures. The findings of this study highlight the need for additional treatment strategies for those with HO and elbow contractures.