JBJS -- Letters to the Editor for Gaur et al., 85 (8) 1538-1543

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Scientific Articles:
Alok Gaur, Marc Sinclair, Enzo Caruso, Giuseppe Peretti, and David Zaleske
Heterotopic Ossification Around the Elbow Following Burns in Children: Results After Excision
J Bone Joint Surg Am 2003; 85: 1538-1543 [Abstract] [Full text] [PDF]

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Results of Surgery for Heterotopic Ossification Around the Elbow: Shawn W. O'Driscoll (30 October 2003)

Results of Surgery for Heterotopic Ossification Around the Elbow 30 October 2003

Shawn W. O'Driscoll,
Professor of Orthopedic Surgery
Mayo Clinic
Send letter to journal:
Re: Results of Surgery for Heterotopic Ossification Around the Elbow

odriscoll.shawn{at}mayo.edu Shawn W. O'Driscoll

In their paper, "Heterotopic Ossification Around The Elbow Following Burns in Children: Results After Excision" by Gaur, et al., the authors have reported the results of contracture release and heterotopic bone excision in nine pediatric patients whose elbows were fused or nearly fused. I am not completely in agreement with the conclusion that "A relatively simple operative and postoperative regimen can achieve satisfactory results."
Of their nine patients, only one achieved a "functional arc of motion" which I would define as 30 to 130� of flexion, the range of motion that affords most patients the possibility of achieving essentially normal activities of daily living (1). Achieving this functional range of motion is also what is considered a criterion for a satisfactory outcome following contracture release around the elbow.(2)
If we were to be more lenient and accept an arc of 40 degrees to 120 degrees of flexion as a satisfactory range of motion, still, only one patient in this study achieved that range. Even when we look at extension and flexion separately, only five of nine patients achieved at least minus 40� of extension and only two patients achieved flexion to at least 120�. Furthermore, four of the patients required manipulation under anesthesia, presumably for unsatisfactory maintenance of their post- operative motion.
These numbers are clearly and dramatically less satisfactory than those reported in several published series of patients treated for contracture release about the elbow, although few of these reports included children and few related to complete bony ankylosis after burns.( 2-17) The reasons could be many, and I certainly do not take issue with those reasons. My main concern is that the expected outcome of a functional arc of motion following contracture release, was not achieved in the large majority of these patients and that we should strive to achieve further improvements in the operative and postoperative care of these patients.
At our institution, we have had fewer satisfactory outcomes following contracture release in pediatric patients when compared to adult patients for reasons that we do not yet fully understand.
REFERENCES
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