Posttraumatic heterotopic ossification of the elbow

Aim. To evaluate the features of formation of posttraumatic heterotopic ossification of the elbow; to develop their classification allowing to differentially resolve the issues of tactics and treatment and outcome predicting.

Methods. 292 patients were observed with elbow fractures and fracture-dislocations (group B and C according to AO/ASIF classification). 40 (14%) of them were diagnosed with posttraumatic heterotopic ossification.

Results. This complication more frequently occurred in fracture-dislocations (23 patients, 57.5%) than in T-U-shaped fractures (13 patients, 32.5%). Thus, the factor of soft tissue trauma plays one of the key roles in the occurrence of this complication. Timelines of ossification occurrence also have some patterns causing a direct relationship with the severity of the damage. Indeed, in fracture-dislocations ossification within 5 weeks after the trauma was identified in 70% of cases, while in T-U-shaped fractures and other damage - only in 40%. Herewith, some correlation is identified for patient’s age and gender: ossification occurs in the early stages more often in men under the age of 30 years. We developed a classification of posttraumatic heterotopic ossification of the elbow allowing to effectively determine the tactics, treatment and prognosis of the outcomes of ossification. In case of mild and moderate severity of ossification management is conservative and functional and occupational prognoses are favorable. In case of severe ossification surgical treatment is recommended. Primary and secondary arthritic changes should be considered. Both functional and professional prognoses are unfavorable. Results of the treatment are: good - 70%, satisfactory - 25% and unsatisfactory - 5%.

Conclusion. Dependence of occurence of posttraumatic heterotopic ossification from a number of factors was determined (magnitude of anatomical damage of the soft tissues surrounding the joint, gender and age, treatment tactics, rehabilitation methods), suggested classification allows to differentially resolve the issues of treatment and outcome prediction.