title: Heterotopic ossification after surgery for distal humeral fractures.
abstract: We retrospectively reviewed 89 consecutive patients (45 men and 44 women) with a mean age at the time of injury of 58 years (18 to 97) who had undergone external fixation after sustaining a unilateral fracture of the distal humerus. Our objectives were to determine the incidence of heterotopic ossification (HO); identify risk factors associated with the development of HO; and characterise the location, severity and resultant functional impairment attributable to the presence of HO. HO was identified in 37 elbows (42%), mostly around the humerus and along the course of the medial collateral ligament. HO was hazy immature in five elbows (13.5%), mature discrete in 20 (54%), extensive mature in 10 (27%), and complete bone bridges were present in two elbows (5.5%). Mild functional impairment occurred in eight patients, moderate in 27 and severe in two. HO was associated with less extension (p = 0.032) and less overall flexion-to-extension movement (p = 0.022); the flexion-to-extension arc was < 100º in 21 elbows (57%) with HO compared with 18 elbows (35%) without HO (p = 0.03). HO was removed surgically in seven elbows. The development of HO was significantly associated with sustaining a head injury (p = 0.015), delayed internal fixation (p = 0.027), the method of fracture fixation (p = 0.039) and the use of bone graft or substitute (p = 0.02).HO continues to be a substantial complication after internal fixation for distal humerus fractures.
authors.affiliation: Department of Orthopaedic Surgery, Shoulder and Elbow Surgery Unit, Fundación Jiménez Díaz, Avda Reyes Católicos, 2, Madrid 28040, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Foruria
authors.affiliation: University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, West Midlands CV2 2DX, UK.
authors.forename: T M
authors.initials: TM
authors.lastname: Lawrence
authors.affiliation: Hopital Vall d´Hebron, Passeig Vall d'Hebron, 119 to 129, 08035 Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Augustin
authors.affiliation: Mayo Clinic, 200 First St. SW, Rochester Minnesota 55905, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: Morrey
authors.affiliation: Mayo Clinic, 200 First St. SW, Rochester Minnesota 55905, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sanchez-Sotelo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Distal humerus fracture; Ectopic bone; HO; Heterotopic ossification