RANGE OF MOTION AND COMPLICATIONS AFTER POSTBURN HETEROTOPIC BONE EXCISION ABOUT THE ELBOW

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.