Bony Cubital Tunnel Syndrome A Case Report of Heterotopic Ossification Causing Circumferential Ulnar Nerve Encasement at the Elbow and Review of Current Management

BackgroundHeterotopic ossification (HO) is a rare but known complication of brain and nerve trauma, orthopedic trauma, and burns. Nerve compression due to HO is extremely rare; bony cubital tunnel syndrome, or compression of the ulnar nerve at the elbow due to HO, is an unusual presentation that requires special considerations for treatment.Case PresentationWe present a 50-year-old man who presented to our hospital after vehicular polytrauma with associated car fire and prolonged extrication. He experienced extensive trauma, with all classically described risks for HO. He developed bony cubital tunnel syndrome, with ulnar neuropathy confirmed on electrodiagnostic studies, and underwent surgical decompression. Surgical decompression revealed circumferential encasement of the ulnar nerve in heterotopic bone, all of which was removed. He demonstrates appropriate recovery of nerve function.Literature ReviewAll perineural HO should be excised early to prevent nerve injury, because excision within 4 months of development is linked to improved functional outcomes. Measures to prevent nerve compression by HO are all associated with delayed wound or bone healing and should be considered on an individual basis.

Automated summary

HO is a rare complication of trauma, and nerve compression due to HO is extremely rare. This case presents a 50-year-old man who developed bony cubital tunnel syndrome and underwent surgical decompression. Excision of perineural HO early is important to prevent nerve injury and improve functional outcomes.