Postoperative single-fraction radiation for prevention of heterotopic ossification of the elbow.
OBJECTIVE
Heterotopic ossification (HO) about the elbow has been described after surgery, trauma, and burns. Even limited deposits can lead to significant functional deficits. Little data exist regarding outcomes of patients treated with radiation therapy (RT) after elbow surgery. We report here the Cleveland Clinic experience with single-fraction radiation following surgery to the elbow. The primary endpoint was the rate of new HO after RT. Secondary endpoints were range of motion, functional compromise, and toxicity.


METHODS
From May 1993 to July 2006, 36 patients underwent elbow surgery followed by single-fraction RT. Range of motion data were collected before and during surgery and at last follow-up. Radiographs were reviewed for persistent or new HO. Patient and treatment factors were analyzed for correlation with development of HO or functional compromise.


RESULTS
Median follow-up was 8.7 months, median age was 42 years, and 75% of patients were male. Twenty-six (72%) patients had HO prior to surgery. All patients had significant limitations in flexion/extension or pronation/supination at baseline. Thirty-one (86%) patients had prior elbow trauma, and 26 (72%) patients had prior surgery. RT was administered a median of 1 day postoperatively (range, 1-4 days). Thirty-four patients received 700 cGy, and 2 patients received 600 cGy. Three (8%) patients developed new HO after RT. All patients had improvement in range of motion from baseline. No patient or treatment factors were significantly associated with the development of HO or functional compromise.


CONCLUSIONS
Single-fraction RT after surgery to the elbow is associated with favorable functional and radiographic outcomes.
Robinson
Clifford G
CG
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Polster
Joshua M
JM
Reddy
Chandana A
CA
Lyons
Janice A
JA
Evans
Peter J
PJ
Lawton
Jeffrey N
JN
Graham
Thomas J
TJ
Suh
John H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000528:radiation effects / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000601:surgery; D011859:Radiography; D011879:Radiotherapy Dosage; D016059:Range of Motion, Articular / Q000528:radiation effects; D012189:Retrospective Studies; D055815:Young Adult; D000092464:Elbow Injuries