S. Djurickovic et al., RANGE OF MOTION AND COMPLICATIONS AFTER POSTBURN HETEROTOPIC BONE EXCISION ABOUT THE ELBOW, The journal of trauma, injury, infection, and critical care, 41(5), 1996, pp. 825-830
Objective: To review the results of surgical management of heterotopic
ossification about the elbow in burned patients. Design: Retrospectiv
e analysis with long-term patient follow-up. Materials and Methods: El
even patients with 16 elbows requiring surgery were admitted between J
anuary 1, 1982 and December 31, 1993, A posterior approach to the elbo
w with release of the encased ulnar nerve +/- anterior transposition a
nd transolecranon osteotomy to access extensive bone formation in the
olecranon fossa was employed, Eight patients (11 elbows) were availabl
e for long-term follow-up conducted at mean 50 +/- 13 months after sur
gery, Long-term follow-up consisted of measurement of range of elbow m
otion, as well as clinical assessment of ulnar nerve function. Main Re
sults: For the 11 elbows examined postoperatively, the mean range of m
otion preoperatively in flexion-extension was 11 degrees +/- 5 degrees
compared to 89 degrees +/- 12 degrees postoperatively (p < 0.001). Th
ree patients with poor long-term results had ankylosis of the joint pr
eoperatively. Of four patients with ulnar nerve paresis preoperatively
, none had ulnar nerve dysfunction at follow-up, Of 16 elbows operated
on, four (25%) had postoperative complications. Two suffered soft-tis
sue breakdown with hardware exposure requiring abdominal flap closure,
one early failure of olecranon fixation, and one late infected hardwa
re. Conclusions: Surgery for both limited range of motion as well as u
lnar nerve compression is effective in cases of heterotopic ossificati
on about the elbows of burned patients, Early operative intervention i
s indicated in progressive disease, particularly ulnar nerve palsy, if
soft-tissue quality is adequate. Complications with 25% of elbows sug
gest that use of olecranon osteotomy for joint access may warrant revi
ew.