Treatment and rehabilitation of post-traumatic elbow stiffness with heterotopic ossification
DOI:
https://doi.org/10.2340/jphs.v59.18363Keywords:
Post-traumatic stiffness, elbow, Heterotopic ossification, Surgical treatment, Early rehabilitationAbstract
Aim: To investigate surgical treatment, postoperative rehabilitation and prevention of heterotopic ossification (HO) in patients with post-traumatic elbow stiffness.
Methods: We performed a retrospective review of patients with post-traumatic elbow stiffness combined with HO between 2007 and 2021. This study was performed on a total of 15 patients (18 elbows) admitted to our hospital, consisting of 12 males and 3 females, with post-traumatic stiffness of the elbow combined with HO, where elbow function could not be recovered by rehabilitation and orthosis treatment. Fifteen patients were treated by surgical excision of heterotopic bones and release of elbow contracture combined with postoperative rehabilitation and orthosis-wearing. Comprehensive treatments, including radiation, oral ibuprofen medication, and manipulation techniques to improve range of motion, were used to prevent HO recurrence. The flexion–extension arc and functional score of the elbow were measured after treatment and compared with the preoperative measurements. Roentgenography was used to observe HO recurrence.
Results: After surgical treatment and postoperative rehabilitation, the patients’ range of motion improved, and the functional score improved considerably. The postoperative flexion-extension arc and The Hospital for Special Surgery (HSS) functional score were statistically significantly higher than the preoperative values (p < 0.01). Roentgenographic examination showed no HO recurrence during the follow-up period.
Conclusion: Surgical excision of heterotopic bones and elbow contracture release combined with postoperative rehabilitation and preventative HO measures can be an effective treatment for cases of post-traumatic elbow stiffness combined with HO, for which conservative treatment is ineffective.
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References
Adolfsson L. Post-traumatic stiff elbow. EFORT Open Rev. 2018;3(5):210–216.
https://doi.org/10.1302/2058-5241.3.170062 DOI: https://doi.org/10.1302/2058-5241.3.170062
Chen S, Yu SY, Yan H, et al. The time point in surgical excision of heterotopic ossification of post-traumatic stiff elbow: recommendation for early excision followed by early exercise. J Shoulder Elbow Surg. 2015;24(8):1165–1171.
https://doi.org/10.1016/j.jse.2015.05.044 DOI: https://doi.org/10.1016/j.jse.2015.05.044
Haglin JM, Kugelman DN, Christiano A, Konda SR, Paksima N, Egol KA. Open surgical elbow contracture release after trauma: results and recommendations. J Shoulder Elbow Surg. 2018;27(3):418–426.
https://doi.org/10.1016/j.jse.2017.10.023 DOI: https://doi.org/10.1016/j.jse.2017.10.023
Bai J, Kuang Z, Chen Y, Hang K, Xu J, Xue D. Serum uric acid level is associated with the incidence of heterotopic ossification following elbow trauma surgery. J Shoulder Elbow Surg. 2020;29(5):996–1001.
https://doi.org/10.1016/j.jse.2020.01.071 DOI: https://doi.org/10.1016/j.jse.2020.01.071
Zhang Z, Zhang Y, Wang Z, Qiu X, Chen Y. Incidence of and risk factors for the development of asymptomatic heterotopic ossification after elbow fracture fixation. J Int Med Res. 2020;48(2):300060519877324.
https://doi.org/10.1177/0300060519877324 DOI: https://doi.org/10.1177/0300060519877324
Viveen J, Doornberg JN, Kodde IF, et al. Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial. BMC Musculoskelet Disord. 2017;18(1):484.
https://doi.org/10.1186/s12891-017-1854-0 DOI: https://doi.org/10.1186/s12891-017-1854-0
Meyer HL, Burggraf M, Polan C, Husen M, Dudda M, Kauther MD. Lollipop sign – ossification at wire ends after osteosynthesis? J Orthop Case Rep. 2019;9(2):52–55.
May RD, Frauchiger DA, Albers CE, et al. Application of cytokines of the bone morphogenetic protein (BMP) family in spinal fusion – effects on the bone, intervertebral disc and mesenchymal stromal cells. Curr Stem Cell Res Ther. 2019;14(8):618–643.
https://doi.org/10.2174/1574888X14666190628103528 DOI: https://doi.org/10.2174/1574888X14666190628103528
Katagiri W, Osugi M, Kawai T, Hibi H. Secreted frizzled-relatedprotein promotes bone regeneration by human bone marrow-derived mesenchymal stem cells. Int J Mol Sci. 2015;16(10):23250–23258.
https://doi.org/10.3390/ijms161023250 DOI: https://doi.org/10.3390/ijms161023250
Joshi AA, Padhye AM, Gupta HS. Platelet derived growth factor-BB levels in gingival crevicular fluid of localized intrabony defect sites treated with platelet rich fibrin membrane or collagen membrane containing recombinant human platelet derived growth factor-BB: a randomized clinical and biochemical study. J Periodontol. 2019;90(7):701–708.
https://doi.org/10.1002/JPER.18-0496 DOI: https://doi.org/10.1002/JPER.18-0496
Manske MC, Hanel DP. Postburn contractures of the elbow and heterotopic ossification. Hand Clin. 2017;33(2):375–388.
https://doi.org/10.1016/j.hcl.2016.12.014 DOI: https://doi.org/10.1016/j.hcl.2016.12.014
Chen JY, Fu CW, Ho HY, Lu YC. Surgical treatment of postburn heterotopic ossification around the elbow: Three case reports. Medicine (Baltimore). 2019;98(6):e14403.
https://doi.org/10.1097/MD.0000000000014403 DOI: https://doi.org/10.1097/MD.0000000000014403
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. Int Orthop. 2017;41(8):1627–1632.
https://doi.org/10.1007/s00264-016-3395-9 DOI: https://doi.org/10.1007/s00264-016-3395-9
Piper SL, Lattanza LL, Shen TS, Wall LB, Goldfarb CA. Open surgical release of posttraumatic elbow contracture in children and adolescents. J Pediatr Orthop. 2019;39(5):241–246.
https://doi.org/10.1097/BPO.0000000000000923 DOI: https://doi.org/10.1097/BPO.0000000000000923
Cancio JM, Rhee P. Therapeutic management of the posttraumatic stiff elbow after open osteocapsular release. Tech Hand Up Extrem Surg. 2018;22(4):134–136.
https://doi.org/10.1097/BTH.0000000000000207 DOI: https://doi.org/10.1097/BTH.0000000000000207
Morcos M, Smith K, Tanzer M. The effect of late radiotherapy on the progression of heterotopic ossification following total hip arthroplasty. Eur J Orthop Surg Traumatol. 2018;28(6):1125–1131.
https://doi.org/10.1007/s00590-018-2185-z DOI: https://doi.org/10.1007/s00590-018-2185-z
Georhakopoulos I, Kouloulias V, Kougiountzopoulou A, et al. Radiation therapy for the prevention of heterotopic ossification: efficacy and toxicity of single fraction radiotherapy. Orthop Rev (Pavia). 2020;12(2):8577.
https://doi.org/10.4081/or.2020.8577 DOI: https://doi.org/10.4081/or.2020.8577
Hu ZH, Chen W, Sun JN, et al. Radiotherapy for the prophylaxis of heterotopic ossification after total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trails. Med Dosim. 2021;46(1):65–73.
https://doi.org/10.1016/j.meddos.2020.07.010 DOI: https://doi.org/10.1016/j.meddos.2020.07.010
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Copyright (c) 2024 Qi Wang , Jiang Peng , Aiyuan Wang , Wenjing Xu , Jinshu Tang, Jinshu Tang
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