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Abstract
Five patients presented with a limited range of motion in their elbow associated with heterotopic ossification. All of these patients underwent surgery within one year. Removal of heterotopic ossification and a posterior capsular release was performed within ten months on average after the initial injury. Each patient postoperatively received prophylaxis consisting of a single-shot radiation of 700 cGY and administration of nonsteroidal anti-inflammatory drugs (NSAIDs) for four weeks on average. With a median follow up period of 21 months, five patients had no radiographic evidence of recurrence. The arc of flexion-extension increased from an average of 64 degrees preoperatively to 133 degrees at the latest follow up. A 12- to 18-month period is generally recommended as necessary for an operation on an ankylosed elbow associated with heterotopic ossification. However, the operative treatment, together with radiation therapy and NSAIDs administration, showed good results within 12 months.
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Figure 1
A 29-year-old male who received conservative treatment for a radial head fracture showed a heterotopic ossification with partial ankylosis around the elbow. (A) Preoperatively, he showed a flexion contracture of approximately 45 degrees and further flexion of approximately 85 degrees in his left elbow. (B) At three months after the injury, x-ray images showed a heterotopic ossification at the posterior and medial side of the elbow. (C) There was no change between x-ray images at month 7 and month 8 (arrows). (D) At 31 months after removal of the heterotopic ossification, follow-up x-ray images showed no evidence for a recurrence of heterotopic ossification. (E) At 31 months postoperatively, the range of motion was approximately 130 degrees compared to 40 degrees preoperatively.
Figure 2
A 24-year-old male with a previous history of open reduction and internal fixation of a medial epicondylar fracture presented with a heterotopic ossification around the elbow. (A) Initially, surgical treatment was administered for the fracture of the medial humeral epicondyle. (B) Preoperatively, the patient showed a flexion contracture of approximately 50 degrees and further flexion of approximately 95 degrees at his left elbow. (C) Five weeks after the initial injury, the heterotopic ossification had emerged on the medial side and the size was gradually increased (circles). (D) Six months after the injury, x-ray images showed a heterotopic ossification at the posterior and medial side of the elbow, which was gradually increased (circles). (E) Ten months after the injury, x-ray images showed matured heterotopic ossification at the posterior and medial side of the elbow. (F) Twelve months after removal of the heterotopic ossification, follow-up x-ray images showed no evidence of recurrence of heterotopic ossification. (G) Twelve months postoperatively, the patient's range of flexion-extension motion was approximately 135 degrees, compared to 45 degrees preoperatively. (H) At 12 months after the operation, he showed an almost normal range of rotation, compared to 100 degrees preoperatively.
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