Risk factors for posttraumatic heterotopic ossification of the elbow: case-control study

Radiotherapy for prevention of heterotopic ossification of the elbow: a systematic review of the literature

BACKGROUND

Heterotopic ossification is a pathological process characterized by abnormal formation of bone in nonskeletal tissue. Radiotherapy for heterotopic ossification of the elbow is questionable because of possible adverse effects.

METHODS

A systematic review of the literature was conducted in MEDLINE, Scopus, ISI Web of Science, National Institute for Health and Clinical Excellence, National Guideline Clearinghouse, System for Information on Grey Literature in Europe, ClinicalTrials.gov, Cochrane Central Register of Clinical Trials, and Cochrane Database of Systematic Reviews up to April 2012. All published articles assessing interventions including radiotherapy for prevention of heterotopic ossification in the elbow of adult patients were considered. Information was recorded by the first two authors, and disagreements in interpretation were resolved by consensus.

RESULTS

In total, 27 studies using radiotherapy for elbow heterotopic ossification were identified (1 randomized clinical trial, 1 case-control study, and 25 case reports and case series) in the literature. Most of them used a single dose of 7.0 Gy. The randomized clinical trial was stopped early because of severe adverse effects (pseudarthrosis) caused by radiation. The case-control study showed that radiotherapy did not effectively prevent recurrence of heterotopic ossification. The case reports and case series mentioned only sparse adverse events.

CONCLUSION

The use of radiation therapy for prevention of heterotopic ossification of the elbow is supported by weak evidence.

Elbow dislocations: a review ranging from soft tissue injuries to complex elbow fracture dislocations

This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness.

Olecranon fractures

Olecranon fractures are common injuries of the upper extremity; majority are treated surgically. A variety of fixation techniques are available to surgeons in modern practice, but there is little comparative clinical research to guide one's decision. Nonetheless, good results over all are to be expected after surgical management. This article presents a review of the current understanding and available evidence in the treatment of olecranon fractures, their relevant anatomy, fracture patterns, fixation options, and outcomes.

Open arthrolysis and hinged external fixation for posttraumatic ankylosed elbows

BACKGROUND

An ankylosed elbow is defined as an elbow having a range of motion of 0°. Movement is extremely limited. This study retrospectively analyzes the results of arthrolysis and hinged external fixation performed on 15 patients suffering from ankylosed elbows.

METHODS

Fifteen completely ankylosed elbows were treated by arthrolysis and hinged external fixation. Patients comprised nine men and six women, with a mean age of 37.93 years (37.93 ± 9.68) when arthrolysis was performed. Before surgery, the elbows were ankylosed at various angles ranging from 30° to 85°. Eleven patients underwent arthrolysis by medial and lateral approaches, three patients by the posterior approach, and one patient by posterior and lateral approaches. Hinged external fixators were applied to all patients. Subcutaneous anterior transposition of the ulnar nerve was performed in all patients.

RESULT

All patients received satisfactory follow-up. The range of motion of the elbow improved from 0° preoperatively to a postoperative mean of 115.67° (115.67 ± 23.29). The Mayo Elbow Performance Score improved from a mean of 67.67 ± 11.00 to 86.67 ± 8.38 points, with excellent results in nine patients, good in five, and fair in one. This difference is statistically significant (t = -6.862; p < 0.001).

CONCLUSION

Open arthrolysis and monolateral hinged external fixation are effective in treating posttraumatic ankylosed elbow. Arthrolysis should be performed by a combination of lateral and medial approaches. In addition, routine hinged external fixation and anterior transposition of the ulnar nerve may improve the postoperative recovery of elbow stiffness.