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Heterotopic Ossification Around the Elbow Following Burns in Children: Results After Excision

Investigation performed at the Boston Shriners Hospital and Massachusetts General Hospital, Boston, Massachusetts

Alok Gaur, MD
Department of Orthopedic Surgery, Hahnemann University Hospital, Philadelphia, PA 19102
Marc Sinclair, MD

Orthopedic Surgery, Altona Children's Hospital, Bleickenallee 38, D-22763 Hamburg, Germany
Enzo Caruso, MD
Orthopaedic Department, Luigi Sacco University Hospital, Milan, Italy

Giuseppe Peretti, MD
Orthopaedic Department, San Raffaele Hospital, Milan, Italy

David Zaleske, MD
Pediatric Orthopaedics Department, Children's National Medical Center, 111 Michigan Avenue, Washington, DC 20010-2970.

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Major burn injuries close to joints alter the function of the musculoskeletal system through tissue loss and limitation of joint motion. In children with involvement of the hand, wrist, and forearm, restriction of elbow motion secondary to heterotopic ossification following a burn injury severely limits the function of the upper extremity. The purpose of this study was to review elbow function following excision of heterotopic ossification around the elbow in children.

Methods: Eight children (ten elbows) from a population of 3245 consecutive patients who were admitted to our pediatric burn center were found to have severe heterotopic ossification of the elbow, leading to an inability to reach the mouth for feeding and the head and the perineum for self-care. Excision of the heterotopic ossification was undertaken if the patient had this limitation of function and if movement was restricted to a total arc of motion of <50°. Pain was not an indication for the operation. The procedure was performed at an average of 17.3 months following the injury.

Results: Seven children (nine elbows) were available for follow-up at an average of fifty-six months after surgery. All nine elbows had an improved arc of motion (an average increase of 57°). Following excision, heterotopic ossification did not recur. All children were able to reach the face and the perineum following the operation.

Conclusions: Excision of heterotopic ossification around the elbow following a burn injury in children can improve the arc of motion and improve the function of the extremity. A relatively simple operative and postoperative regimen can achieve satisfactory results.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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