Heterotopic Ossification of the Elbow: A Literature Review

Abstract

Background: Aberrant ectopic bone formation of the elbow is a common clinical presentation after neurologic, burn, and traumatic injuries to the joint. This represents a significant source of patient burden, delayed recovery times and increased medical costs. Although there is an abundance of literature on heterotopic ossification (HO) of the hip, there is little literature on HO of the elbow in comparison. Aims: This literature review seeks to summarize consensus regarding the appropriate system of classification, pathophysiology, clinical presentation, risk factors, and prophylactic treatment options associated with HO formation of the elbow. Clinicians may utilize this information to identify high risk patient populations for potential prophylactic therapy to prevent the occurrence/complications of HO at the elbow. Methods: A PubMed literature review was conducted using combinations of the key words “heterotopic ossification,” “elbow,” and “fracture/dislocation.” All study types were considered and relevant articles were utilized for this review. Results: Higher levels of injury, severe neurologic and burn injuries, delay to surgery, delay in fixation/stabilization of the elbow, multiple surgical treatments, and genetics were correlated with ectopic bone formation. Single dose pre/postoperative radiotherapy with 700cGy or preoperative NSAID regiments were found to be the main prophylactic treatments.  Conclusion: Clinicians must consider the HO risk profile of their patients as well as the risk factors of treatment before deciding on prophylactic options. Surgical resection is reserved for the most severe cases.