Successful Elbow Contracture Release Secondary to Melorheostosis

Abstract

Melorheostosis is a rare, noninheritable developmental dysplasia of cortical bone that is often characterized by a classic radiographic pattern of flowing hyperostosis along the cortex of long bones1. Patients with this condition may have joint pain, stiffness, deformity, and restricted range of motion due to soft-tissue contracture2. Involvement usually follows a sclerotomal distribution3 and usually affects only one extremity4,5. Joint contracture occurs when the abnormal ossification in the cortex of the long bone involves the soft tissues and extends into the joint, resulting in soft-tissue fibrosis and contracture2,5,6. There is no specific treatment for this condition; options range from nonsurgical management (e.g., splinting and early training in making optimal use of the unaffected extremity) to various types of surgical management (e.g., tendon lengthening, sympathectomy, implant arthroplasty, or even amputation2. The literature indicates that surgical release of a joint contracture may be difficult and that recurrence of the deformity is frequent2,4-6. Melorheostosis of the elbow is rare compared with that of the lower extremity, and a thorough search of the literature revealed no reports on surgical release of a stiff elbow caused by this condition. We report the case of a thirty-seven-year-old man who had a fixed flexion contracture of the elbow as a result of isolated melorheostotic involvement of the proximal part of the ulna and who obtained a functional range of motion after open release of the elbow. The patient was informed that data concerning the case would be submitted for publication, and he consented. A thirty-seven-year-old man presented with limitation of motion of the left, nondominant elbow. He reported that pain and limited elbow motion had developed after he played a game of squash five …