Range of motion and complications after postburn heterotopic bone excision about the elbow.

Objective : To review the results of surgical management of heterotopic ossification about the elbow in burned patients. Design : Retrospective analysis with long-term patient follow-up. Materials and Methods : Eleven patients with 16 elbows requiring surgery were admitted between January 1, 1982 and December 31, 1993. A posterior approach to the elbow with release of the encased ulnae nerve ± anterior transposition and transolecranon osteotomy to access extensive bone formation in the olecranon fossa was employed. Eight patients (11 elbows) were available for long-term follow-up conducted at mean 50 ± 13 months after surgery. Long-term follow-up consisted of measurement of range of elbow motion, as well as clinical assessment of ulnae nerve function. Main Results : For the 11 elbows examined postoperatively, the mean range of motion preoperatively in flexion-extension was 11° ± 5° compared to 89° ± 12° postoperatively (p < 0.001). Three patients with poor long-term results had ankylosis of the joint preoperatively. Of four patients with ulnae nerve paresis preoperatively, none had ulnae nerve dysfunction at follow-up. Of 16 elbows operated on, four (25%) had postoperative complications. Two suffered soft-tissue breakdown with hardware exposure requiring abdominal flap closure, one early failure of olecranon fixation, and one late infected hardware. Conclusions : Surgery for both limited range of motion as well as ulnae nerve compression is effective in cases of heterotopic ossification about the elbows of burned patients. Early operative intervention is indicated in progressive disease, particularly ulnar nerve palsy, if soft-tissue quality is adequate. Complications with 25% of elbows suggest that use of olecranon osteotomy for joint access may warrant review.