title: Clinically relevant heterotopic ossification after elbow fracture surgery: a risk factors study.
abstract: BACKGROUND
  Heterotopic ossification (HO) is a common complication of elbow fracture surgery that can significantly impair function and range of motion (ROM). Whereas numerous studies have assessed HO after hip trauma or replacement surgery, few data have been reported on the prevalence and risk factors of HO after elbow fractures.
  
  
  OBJECTIVE
  Our objective was to investigate the prevalence and risk factors of clinically relevant HO after elbow fracture surgery under the hypothesis that the ability to identify high-risk patients would improve treatment tailoring and assist in meeting patient expectations.
  
  
  METHODS
  We retrospectively included consecutive patients who had surgery for elbow injuries between January 2007 and December 2011. Patient demographics, operative details, and radiographs were reviewed.
  
  
  RESULTS
  Of 124 elbows in 122 patients, 38 (30.6%) had HO and 26 (21%) clinically relevant HO. The prevalence of clinically relevant HO was highest in floating elbow injury, followed by combined olecranon and radial head fractures, types A and B distal humerus fractures, and terrible triad injury. By multiple logistic regression, factors that independently predicted clinically relevant HO were fracture-dislocation (OR, 4.87; 95%CI, 1.78-13.29; P=0.002) and longer time to surgery (P<0.05). Of the 26 patients with clinically relevant HO, 6 (23%) eventually required revision elbow surgery to improve ROM.
  
  
  CONCLUSIONS
  HO of the elbow occurred in almost one-third of our patients with surgically treated elbow fractures. Fracture-dislocation of the elbow and longer time to surgery independently predicted HO responsible for ROM loss. Clinically relevant HO was associated with significant morbidity.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore. Electronic address: choonchiet@gmail.com.
authors.forename: C C
authors.initials: CC
authors.lastname: Hong
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors.forename: N
authors.initials: N
authors.lastname: Nashi
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors.forename: H W
authors.initials: HW
authors.lastname: Hey
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors.forename: Y H
authors.initials: YH
authors.lastname: Chee
authors.affiliation: University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, 1E Kent Ridge Road, Singapore 119228, Singapore.
authors.forename: D
authors.initials: D
authors.lastname: Murphy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult; D000092464:Elbow Injuries
keywords: Elbow fracture; Elbow surgery; Heterotopic ossification; Range of motion; Risk factors