Treatment of heterotopic ossification of the elbow following burn injury: Recommendations for surgical excision and perioperative prophylaxis using radiation therapy

Background: Heterotopic ossification (HO) is reported to occur in 0.1-3.3% of elbows after a severe burn, and can significantly limit elbow motion and upper extremity function. Methods: The study included 9 patients (11 elbows) treated by the senior author (TW). The surgical technique consisted of making multiple small surgical approaches to remove heterotopic ossification (without raising cutaneous flaps) and concomitantly releasing the elbow capsule and skin contracture. Perioperative radiation therapy was performed to decrease heterotopic ossification recurrence. Outcome measures included postoperative elbow range of motion and Mayo Elbow Performance Score. Results: The average amount of body surface area burned was 54% (range, 10-86%) and mean time from injury to elbow surgery was 416 days (range, 175-860). All elbows had some degree of direct involvement with the thermal injury. Preoperative arc of motion averaged 39 degrees in flexion/extension and 78 degrees in supination/pronation. Four elbows had complete ankylosis in the flexion/extension plane and 1 had only 5 degrees of motion. At last follow-up, arc of motion in flexion/extension averaged 116 degrees and 139 degrees in supination/pronation, an improvement of 77 degrees and 61 degrees, respectively. One recurrence of HO required re-excision. Conclusion: We recommend this multiple-approach surgical technique for treatment of heterotopic ossification and elbow contracture after burn injury, along with perioperative radiation therapy to decrease recurrence. Our surgical approach and treatment resulted in significant gains in elbow motion and upper extremity function with few complications.