Posttraumatic Elbow Contracture

Gregory Rafijah


Curr Orthop Pract. 2014;25(3):213-216. 

In This Article

Heterotopic Ossification

Ectopic bone may form around the elbow after periarticular trauma especially in the setting of central nervous system injury or a major burn.[23] The pathogenesis of heterotopic bone formation is not completely understood. Prevention is the mainstay of treatment with excision often necessary to restore motion. Preventative measures that may inhibit ectopic bone formation include early and consistent range of motion exercises, use of indomethacin, bisphosphonates, and radiation therapy.[9] Once ectopic bone forms, a severe contracture or even ankylosis of the elbow may result requiring surgical treatment.[24] Heterotopic bone also may occur between the proximal radius and ulna, resulting in a synostosis that requires surgical release to restore forearm rotation.[25]

Historically, heterotopic ossification excision is performed after maturity of heterotopic bone is achieved as proven by normalization of alkaline phosphatase levels, quiescent bone scans and solidification on plain radiographs. Early excision of heterotopic bone has been recommended for elbow involvement since upper extremity impairment can be severe. Therefore, resection of heterotopic ossification can proceed when the soft-tissue envelope demonstrates mature scars and resolution of inflammation.[24] In fact, delay of heterotopic ossification excision greater than 1 yr may result in an increased risk of recurrence of heterotopic ossification,[26] especially in cases requiring extensive release. Morimoto reported a series of ''early excision'' of elbow heterotopic ossification at an average of 7.7mo after injury with good results and maintenance of the functional recovery gained after release.[9]