Progression of Heterotopic Ossification around the Elbow after Trauma

Document Type : RESEARCH PAPER

Authors

Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Boston, MA

Abstract

 Background:
This study addresses the null hypothesis that there is no expansion of heterotopic ossification (HO) in the
elbow beyond what can be seen early on.  

Methods:

The area of HO was measured on lateral radiographs of 38 consecutive patients that had operative treatment of HO between 2000 and 2013. Measurements from radiographs obtained between 3 to 7 weeks were compared to measurements from radiographs made 3 months or more after injury.

Results:

There was no significant difference between the average area of HO on the first (median 2.8 square centimeters, Q1: 1.5, Q3: 5.1) and later radiographs (median of 2.8 square centimeters, Q1: 1.4, Q3: 5.0) (P = 0.99).
Discussion: According to our results the area of HO does not expand beyond what can be seen early in the disease process. 
 

Keywords

Main Subjects


1. Foruria AM, Augustin S, Morrey BF, Sanchez-Sotelo
J. Heterotopic ossification after surgery for fractures
and fracture-dislocations involving the proximal
aspect of the radius or ulna. J Bone Joint Surg Am.
2013; 95(10):e66.
2. Wiggers JK, Helmerhorst GT, Brouwer KM, Niekel
MC, Nunez F, Ring D. Injury complexity factors
predict heterotopic ossification restricting motion
after elbow trauma. Clin Orthop Relat Res. 2014;
472(7):2162-7.
3. Potter BK, Forsberg JA, Davis TA, Evans KN,
Hawksworth JS, Tadaki D, et al. Heterotopic
ossification following combat-related trauma. J Bone
Joint Surg Am. 2010; 92(Suppl 2):74-89.
4. Abrams GD, Bellino MJ, Cheung EV. Risk factors for
development of heterotopic ossification of the elbow
after fracture fixation. J Shoulder Elbow Surg. 2012;
21(11):1550-4.
5. Brownley RC, Agarwal S, Loder S, Eboda O, Li J,
Peterson J, et al. Characterization of heterotopic
ossification using radiographic imaging: evidence for
a paradigm shift. PloS One. 2015; 10(11):e0141432.
6. Murnaghan M, Li G, Marsh DR. Nonsteroidal antiinflammatory
drug-induced fracture nonunion: an
inhibition of angiogenesis? J Bone Joint Surg Am.
2006; 88(Suppl 3):140-7.
7. Hamid N, Ashraf N, Bosse MJ, Connor PM, Kellam
JF, Sims SH, et al. Radiation therapy for heterotopic
ossification prophylaxis acutely after elbow trauma:
a prospective randomized study. J Bone Joint Surg
Am. 2010; 92(11):2032-8.
8. McAuliffe JA, Wolfson AH. Early excision of
heterotopic ossification about the elbow followed
by radiation therapy. J Bone Joint Surg Am. 1997;
79(5):749-55.
9. Salazar D, Golz A, Israel H, Marra G. Heterotopic
ossification of the elbow treated with surgical resection:
risk factors, bony ankylosis, and complications. Clin
Orthop Relat Res. 2014; 472(7):2269-75.