This is a retrospective review of 37 patients with post-traumatic elbow contractures. The authors compared the results of contracture release in 16 patients who had associated heterotopic ossification to those results in 21 patients who had capsular contracture alone with no heterotopic ossification. The goal of the study was to test the hypothesis that heterotopic ossification is associated with diminished motion after the release. The authors were able to conclude convincingly that open release of post-traumatic elbow stiffness is more effective when heterotopic ossification hinders the motion, rather than when there is capsular ligamentous contracture alone.
The significance of this article is that heterotopic ossification which truly blocks elbow motion may, in fact, be a positive prognostic factor for a better improvement after index elbow release than with isolated capsular ligamentous contracture alone. The procedure may be more complicated, and soft-tissue release is often required when removing the ectopic bone in stiff elbows in order to recover motion. However, the prognosis does not seem to be affected by heterotopic bone as long as that there is a congruous elbow joint present with adequate cartilage.
Elbow, Contracture, Release, Heterotopic, Ossification, Stiffness