This article reviews the results of operative release of complete ankylosis of the elbow due to heterotopic ossification in patients with either a severe burn or trauma. Eleven limbs in 7 patients underwent contracture release after a severe burn. The position of ankylosis was an average of 47degrees of flexion (range, 30-90 degrees of flexion) and 7 degrees of pronation. Three of these patients required free micro vascular lattissimus dorsi flap coverage at the time of the contracture release. Four of the 11 burn elbows failed to regain at least 80 degrees of ulno-humeral motion but only 1 of the recurrent contractures was due to recurrent heterotopic bone. This led to recurrence of complete ankylosis. Three of the 4 limbs had a second operation for recurrent contracture but only 1 led to an increase of more than 20 degrees of motion. Four limbs had persistent radio-ulnar synostosis at final follow-up. At final evaluation, the average arc of ulno-humeral motion was 81 degrees (range, 20-115 degrees) with average flexion of 111 degrees and an average flexion contracture of 30 degrees. According to the system of Broberg and Morrey, the final result was rated as good in 6 elbows, fair in 4 and poor in 1 elbow.
There were 9 elbows in 8 patients who underwent elbow contracture release for posttraumatic ankylosis. Five of the 9 limbs had a grade II open wound. The position of ankylosis average 66 degrees of flexion (range, 30-90 degrees of flexion) with all limbs ankylosed in neutral rotation. One patient in the posttraumatic group developed a sensory and motor ulnar neuropathy associated with recurrent heterotopic ossification necessitating a revision cubital tunnel decompression and contracture release. Three patients also required additional surgery to improve motion. After the repeat resections, the average arc of ulnar-humeral motion was 93 degrees (range, 40-110 degrees) with average flexion of 121 degrees and an average flexion contracture of 27 degrees. According to the system of Broberg and Morrey, the result was rated as good for 5 elbows, fair for 3 and poor for 1 elbow.
This study outlines marginal results for treatment of complete ankylosis of the elbow due to heterotopic bone related to burns and trauma. There was a high incidence of recurrent contracture with 8 of 20 limbs undergoing revision surgery either for revision contracture release, ulnar nerve decompression or fracture of the ulna. Despite a significant number of patients not achieving an 80 degree arc of ulno-humeral motion and many requiring revision operative intervention, there was a high patient satisfaction rate averaging 8 points in both groups on a 10-point scale. This article supports the attempt for improved motion and function in complete elbow ankylosis. However, realistic expectations provided to the patient may overall improve patient satisfaction.
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