[Excision of heterotopic new bone around the elbow in patients with head injury: 51 cases].
OBJECTIVE
Neurogenic paraosteoarthropathy of the elbow is a frequent complication in head injury patients. The functional impairment may be severe. The purpose of this work was to evaluate the efficacy of our medico-surgical approach and to determine indications for surgery.


METHODS
We analyzed retrospectively a continuous series of 44 patients (51 elbows) with neurogenic heterotopic new bone of the elbow joint managed from 1993 to 2000. The heterotopic bone had developed on a central deficit limb in 70% of the patients. Flexion-extension was limited in all patients, and pronation-supination in nine. The ulnar nerve was compressed by the heterotopic bone in half of the patients. A 3D reconstruction CT-scan with contrast injection was obtained in all patients. We consider did not the classical criteria for bone maturation to assess operability. Using an adapted approach, we removed the heterotopic new bone to enable complete elbow motion. Associated procedures were performed in fifteen patients due to persistent intraoperative joint stiffness related to muscle-tendon retraction. We did not prescribe diphosphonates or radiotherapy postoperatively.


RESULTS
At 45 months follow-up, one patient had been lost. Relative gain was considered very good in 34 elbows, good in 13 and fair in 3. There were no cases of lost motion. There were no recurrences causing joint limitation, but two of nine cases of radioulnar synostosis recurred.


CONCLUSIONS
Neurogenic paraosteopathy of the elbow impairs joint function and may lead to ulnar nerve compression. The goal of surgery is to improve function. The analysis of our results show that early surgery yields good results without complementary treatment, irrespective of the patient's overall functional deficit or cognitive status and irrespective of the localization of the hetertopic bone. The essential prognostic factor for the quality results is the neurological status of the limb, particularly the degree of spasticity and muscle-tendon retraction.
Sorriaux
G
G
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches.
Denormandie
P
P
Martin
J N
JN
Kiefer
C
C
Judet
T
T
D000328:Adult; D001859:Bone Neoplasms / Q000209:etiology / Q000601:surgery*; D006259:Craniocerebral Trauma / Q000150:complications; D004551:Elbow Joint; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010016:Osteoma / Q000209:etiology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies