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Erschienen in:
07.07.2023 | Review Article
Heterotopic ossification of the elbow: a current concepts review
Erschienen in: Obere Extremität | Ausgabe 3/2023
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Background
Heterotopic ossification (HO) is defined as the formation of mature lamellar bone in non-skeletal tissues. Heterotopic ossification of the elbow is recognized as an uncommon but challenging complication following specific mechanisms of injury. However, the underlying pathophysiology as well as the optimal management and prophylaxis strategies continue to be debated.
Methods
We reviewed the available literature searching Medline via the PubMed interface. The main objective was to highlight current concepts of the pathophysiology, risk factors, diagnostic modalities, treatment practices, and prophylaxis recommendations of elbow HO.
Results
Heterotopic ossification of the elbow is commonly observed after trauma or surgery (3%–89%), CNS injuries (20%), and burns (0.1%–3%). The pathologic recruitment, activation, and expansion of chondro-osseous progenitors is affected by the local microenvironment resulting in formation of ectopic bone. Risk factors include specific mechanisms of injury, patient morbidity, and treatment modalities. Standard radiographs are usually sufficient for clinical assessment; however, ultrasound may be used as an early diagnostic modality and computed tomography (CT) scans can facilitate preoperative planning. Nonsteroidal anti-inflammatory drugs (NSAIDs) and radiation therapy (RT) are the most common prophylactic options for HO. In advanced stages, surgical resection has been found to improve patient outcomes regardless of the initial cause of injury.
Conclusion
Elbow HO is a diverse pathologic process with specific risk factors related to the individual etiology. The prophylactic use of NSAIDs and RT needs to be further investigated in the context of elbow HO. Patients with persistent functional impairment due to the disorder may be treated effectively by open or arthroscopic excision.