title: Resection of elbow ossification and continuous passive motion in postcomatose patients.
abstract: Heterotopic periarticular ossifications were surgically excised in 16 elbows of 14 traumatic brain injury patients an average of 18.9 months (range, 4-67 months) after the end of coma. In 11 elbows the ulnohumeral joint was ankylosed in a position that ranged from 0 degrees to 100 degrees of flexion (group 1); in 5 elbows the arc of flexion ranged from 10 degrees to 25 degrees (group 2). Full pronation and supination were present in 15 of the elbows; in 1 the radiocapitellar joint was fixed at 30 degrees of pronation by a partial ossification of the interosseous membrane. The arc of flexion attained after surgery averaged 115 degrees (range, 90 degrees to 145 degrees) in the group 1 elbows and 128 degrees (range, 115 degrees to 140 degrees) in the group 2 elbows. In an attempt to prevent postoperative loss of motion and recurrence of ossification, continuous passive motion was applied to the affected elbow for 6 weeks before starting a fully active rehabilitation program. All the patients were examined at regular intervals after the surgery. The follow-up period ranged from 12 to 60 months (average, 30.7 months). During the follow-up period, all the elbows showed improvement in range of motion and the arc of flexion averaged 95 degrees (range, 30 degrees to 135 degrees) in the group 1 elbows and 116 degrees (range, 80 degrees to 145 degrees) in the group 2 elbows. Patients with poor neuromuscular control lost part of their postoperative range of motion and partial recurrence was observed in 3 elbows. We believe that our improved results, compared with those obtained by previous investigators, may have been due to the prolonged application of continuous passive motion after surgery.
authors.affiliation: Department of Orthopedic Surgery, University of Rome Tor Vergata, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ippolito
authors.forename: R
authors.initials: R
authors.lastname: Formisano
authors.forename: R
authors.initials: R
authors.lastname: Caterini
authors.forename: P
authors.initials: P
authors.lastname: Farsetti
authors.forename: F
authors.initials: F
authors.lastname: Penta
mesh_terms: D000293:Adolescent; D000328:Adult; D001930:Brain Injuries / Q000150:complications* / Q000503:physiopathology; D003128:Coma; D004550:Elbow / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015915:Motion Therapy, Continuous Passive; D009999:Ossification, Heterotopic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D016896:Treatment Outcome