Early surgical management for heterotopic ossification about the elbow presenting as limited range of motion associated with ulnar neuropathy.

BACKGROUND: The formation of heterotopic ossification (HO) about the elbow after traumatic injury has been well documented in the literature. The optimal treatment, however, for ectopic bone associated with restricted range of motion and ulnar nerve entrapment syndrome has not been established. METHODS: Seven elbows with HO in 7 patients admitted to Chang Gung Memorial Hospital from April 1998 to January 1999 presented with limited range of motion and associated ulnar nerve neuropathy. All of these patients received early surgical excision of HO combined with release of the encased ulnar nerve and anterior transposition, followed by early gentle passive physical therapy and active exercise within the pain-free range of motion postoperatively. RESULTS: Almost full range of motion and complete functional ability following surgery were recovered in 6 of the 7 patients, while I patient who suffered from multiple traumatic injuries had limited improvement from 45 degrees ankylosis to 10 degrees approximately 90 degrees of a flexion-extension motion arc. CONCLUSION: Our results suggest that early surgical management combined with gentle physical therapy postoperatively is a feasible modality for treating patients with post-traumatic HO about the elbow presenting as limited range of motion and associated ulnar nerve compression syndrome.