Skip to main content
SpringerLink
Log in

Results and outcome predictors after open release of complete ankylosis of the elbow caused by heterotopic ossification

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

Background

Heterotopic ossification (HO) may lead to complete elbow ankylosis, resulting in severe disability. The prognostic factors that may be valuable in guiding treatment of this condition have not yet been evaluated. The goals of this study were to describe the outcomes of open release for ankylosed elbow caused by HO and to analyse factors associated with clinical outcomes.

Method

This retrospective study assessed 41 patients with ankylosed elbows treated by open release surgery. We report final clinical outcomes and analyses of the association between outcomes and clinical variables.

Results

Mean patient age was 36.4 years; follow-up was 36.1 months. Mean arc of motion increased from 0 to 112° post-operatively, mean pronation from 34 to 52°, supination from a mean of 51 to 76°, and Mean Mayo Elbow Performance Score (MEPS) from 42.8 to 84.2. Eight patients experienced recurrence, two of whom underwent a second operation: one for elbow instability and one for revision surgery. Linear regression analysis demonstrated that initial injury type (p = 0.020), articular surface damage (p = 0.001), coma iduringthe initial injury (p = 0.001) and concomitant radial head replacement (p = 0.029) were independent factors affecting the final MEPS.

Conclusions

Satisfactory outcomes were achieved, indicating that open release is effective for ankylosed elbows. Our findings demonstrated that initial injury type, articular surface damage, coma and radial head replacement are outcome predictors affecting final outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lee EK, Namdari S, Hosalkar HS, Keenan MA, Baldwin KD (2013) Clinical results of the excision of heterotopic bone around the elbow: a systematic review. J Should Elb Surg 22(5):716–722. doi:10.1016/j.jse.2012.11.020

    Article  Google Scholar 

  2. McAULIFFE JA, Wolfson AH (1997) Early excision of heterotopic ossification about the elbow followed by radiation therapy. J Bone Joint Surg Am 79(5):749–755

    Article  CAS  PubMed  Google Scholar 

  3. Baldwin K, Hosalkar HS, Donegan DJ, Rendon N, Ramsey M, Keenan MAE (2011) Surgical resection of heterotopic bone about the elbow: an institutional experience with traumatic and neurologic etiologies. J Hand Surg 36(5):798–803

    Article  Google Scholar 

  4. Gaur A, Sinclair M, Caruso E, Peretti G, Zaleske D (2003) Heterotopic ossification around the elbow following burns in children: results after excision. J Bone Joint Surg Am 85-A(8):1538–1543

    Article  PubMed  Google Scholar 

  5. Ruan HJ, Liu S, Fan CY, Liu JJ (2013) Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows. Arch Orthop Trauma Surg 133(2):179–185. doi:10.1007/s00402-012-1659-4

    Article  PubMed  Google Scholar 

  6. Ring D, Jupiter JB (2003) Operative release of complete ankylosis of the elbow due to heterotopic bone in patients without severe injury of the central nervous system. J Bone Joint Surg Am 85(5):849–857

    Article  PubMed  Google Scholar 

  7. Ring D, Jupiter JB (2004) Operative release of ankylosis of the elbow due to heterotopic ossification. J Bone Joint Surg Am 86(suppl 1):2–10

    Article  PubMed  Google Scholar 

  8. Morrey BF (1990) Post-traumatic contracture of the elbow. Operative treatment, including distraction arthroplasty. J Bone Joint Surg Am 72(4):601–618

    Article  CAS  PubMed  Google Scholar 

  9. Koh KH, Lim TK, Lee HI, Park MJ (2013) Surgical treatment of elbow stiffness caused by post-traumatic heterotopic ossification. J Should Elb Surg 22(8):1128–1134. doi:10.1016/j.jse.2013.04.019

    Article  Google Scholar 

  10. Hastings HI, Graham T (1994) The classification and treatment of heterotopic ossification about the elbow and foream. Hand Clin 10:417–451

    PubMed  Google Scholar 

  11. Park MJ, Chang MJ, Lee YB, Kang HJ (2010) Surgical release for post-traumatic loss of elbow flexion. J Bone Joint Surg 92(16):2692–2699

    Article  PubMed  Google Scholar 

  12. Thompson HC 3rd, Garcia A (1967) Myositis ossificans: aftermath of elbow injuries. Clin Orthop Relat Res 50:129–134

    Article  PubMed  Google Scholar 

  13. Salazar D, Golz A, Israel H, Marra G (2014) Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications. Clin Orthop Relat Res 472(7):2269–2275

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morrey B, Tanaka S, An K (1991) Valgus stability of the elbow. A definition of primary and secondary constraints. Clin Orthop Relat Res 265:187–195

    Google Scholar 

  15. Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJ (2004) The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg Am 86(8):1730–1739

    Article  PubMed  Google Scholar 

  16. Hall JA, McKee MD (2005) Posterolateral rotatory instability of the elbow following radial head resection. J Bone Joint Surg Am 87(7):1571–1579. doi:10.2106/JBJS.D.02829

    PubMed  Google Scholar 

  17. Jensen SL, Olsen BS, Tyrdal S, Sojbjerg JO, Sneppen O (2005) Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture: efficacy of prosthetic replacement and ligament repair. J Should Elb Surg 14(1):78–84. doi:10.1016/j.jse.2004.05.009

    Article  Google Scholar 

  18. Yu SY, Yan HD, Ruan HJ, Wang W, Fan CY (2015) Comparative study of radial head resection and prosthetic replacement in surgical release of stiff elbows. Int Orthop 39(1):73–79. doi:10.1007/s00264-014-2594-5

    Article  PubMed  Google Scholar 

  19. van Kampen PJ, Martina JD, Vos PE, Hoedemaekers CW, Hendricks HT (2011) Potential risk factors for developing heterotopic ossification in patients with severe traumatic brain injury. J Head Trauma Rehabil 26(5):384–391. doi:10.1097/HTR.0b013e3181f78a59

    Article  PubMed  Google Scholar 

  20. Hurvitz EA, Mandac BR, Davidoff G, Johnson JH, Nelson VS (1992) Risk factors for heterotopic ossification in children and adolescents with severe traumatic brain injury. Arch Phys Med Rehabil 73(5):459–462

    CAS  PubMed  Google Scholar 

  21. Roberts JB, Pankratz DG (1979) The surgical treatment of heterotopic ossification at the elbow following long-term coma. J Bone Joint Surg Am 61(5):760–763

    Article  CAS  PubMed  Google Scholar 

  22. Chalidis B, Stengel D, Giannoudis PV (2007) Early excision and late excision of heterotopic ossification after traumatic brain injury are equivalent: a systematic review of the literature. J Neurotrauma 24(11):1675–1686. doi:10.1089/neu.2007.0342

    Article  PubMed  Google Scholar 

  23. Streubel PN, Cohen MS (2015) Open surgical release for contractures of the elbow. J Am Acad Orthop Surg 23(6):328–338. doi:10.5435/JAAOS-D-14-00051

    Article  PubMed  Google Scholar 

  24. Maender C, Sahajpal D, Wright T (2010) Treatment of heterotopic ossification of the elbow following burn injury: recommendations for surgical excision and perioperative prophylaxis using radiation therapy. J Should Elb Surg 19(8):1269–1275. doi:10.1016/j.jse.2010.05.029

    Article  Google Scholar 

  25. Jupiter JB, O’Driscoll SW, Cohen MS (2003) The assessment and management of the stiff elbow. Instr Course Lect 52:93–111

    PubMed  Google Scholar 

  26. Viola R, Hn H (2000) Treatment of ectopic ossification about the elbow. Clin Orthop Relat Res 370:65–68

    Article  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, People’s Republic of China

      Shuai Chen, Jiazhi Liu, Wei Zheng, Zhiwei Li, Wei Chen & Cunyi Fan

    2. Taishan Medical University, 619 Changcheng Road, Taian, 271016, People’s Republic of China

      Jiazhi Liu

    3. Fudan University Sports Medicine Center & Department of Sports Medicine and Arthroscopy Surgery, Huashan Hospital, Fudan University, No. 12, Middle Urumqi Road, Shanghai, 200040, People’s Republic of China

      Jiangyu Cai

    Authors
    1. Shuai Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Jiazhi Liu
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Jiangyu Cai
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Wei Zheng
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Zhiwei Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Wei Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Cunyi Fan
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Cunyi Fan.

    Ethics declarations

    Source of funding

    The funding source did not play a role in our investigation.

    Conflict of interest

    None

    Additional information

    Shuai Chen, Jiazhi Liu and Jiangyu Cai contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Chen, S., Liu, J., Cai, J. et al. Results and outcome predictors after open release of complete ankylosis of the elbow caused by heterotopic ossification. International Orthopaedics (SICOT) 41, 1627–1632 (2017). https://doi.org/10.1007/s00264-016-3395-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00264-016-3395-9

    Keywords

    Search

    Navigation