Abstract
We studied twenty-four patients (twenty-seven elbows) that underwent resection of heterotopic ossification about the elbow. All of the patients had suffered from a traumatic brain injury. In addition, eight of the patients suffered local trauma, either fracture or burn. All patients had surgery performed by one of two surgeons (MAK, MDL). The mean follow-up was 25.9± 2.6 months with a minimum of 12 months.
Maximum flexion increased from 80.1 ± 7.8 degrees preoperative to 111.9± 4.5 degrees postoperative (p=0.0003). Maximum extension increased from 58.9 ± 6.2 degrees preoperative to 32.1 ± 5.3 degrees postoperative (p=0.0005). Twenty-three of the 27 elbows gained motion, with 4 patients loosing an average of 15.0 ± 5.8 degrees. Interestingly, in the 17 patients who had ankylosed elbows preoperatively, the average gain in motion was 59.1 ± 10.6 degrees as compared to a gain of 23.2 ± 11.0 degrees in the remaining 10 patients (p=0.03). The time from injury until resection was a significant predictor of outcome, with longer times associated with worse outcome (p=0.02). Those patients who had continuous passive motion (CPM) after surgery had better motion gain (57.9 ± 4.3 degrees) than those that did not have CPM (24.1 ± 7.9 degrees) (p=0.04).
Resection of heterotopic ossification about the elbow is effective in gaining motion in most patients. The surgery can be technically challenging and requires extensive preoperative planning. Patients who have greater loss of motion preoperatively (i.e., ankylosed) have better outcomes than those with less to gain. Continuous passive motion should be considered postoperatively as its use is associated with a better result.