Treatment of ectopic ossification about the elbow

Abstract

The surgical treatment of elbow ectopic ossification associated with elbow stiffness has progressed significantly in the past decade. Although previous reports describe inconsistent results and high complication rates, numerous recent reports document not only good results, but also lower complication rates. The current study outlines the authors' treatment of patients with ectopic bone about the elbow. Various modalities have been used for prophylaxis against elbow ectopic ossification in the patient with elbow trauma. However, despite these prophylaxis efforts, periarticular ossification may form and result in disabling elbow stiffness. If ectopic ossification and stiffness develop, operative intervention may be indicated to restore motion. It has been long suggested that operative intervention be delayed for at least 1 year, with earlier intervention thought to predispose to recurrence. Recent reports, however, have documented good results with earlier intervention, from 3 to 6 months after injury. The evaluation of posttraumatic elbow stiffness associated with ectopic ossification is described, followed by a discussion regarding anatomic and functional classifications. Surgery is based on multiple factors including the location of ectopic ossification, the plane(s) of elbow stiffness, and the presence of associated nerve compression. A limited or extended Kocher approach may be used to release most contractures; however, other approaches may be necessary. Surgical technique is described in detail. Meticulous surgical technique is necessary to avoid complications, including triceps avulsion, recurrent elbow stiffness, and hematoma.