This is a team-based review of posttraumatic elbow contracture caused by heterotopic ossification. It walks through diagnosis, nonoperative management, open arthrolysis with HO excision, and structured rehabilitation. The roles of the orthopaedic surgeon and physical therapist are laid out at each stage of care.
Anchor every treatment decision to the functional arc: 100° of flexion (30° to 130°) and 100° of rotation. When a posttraumatic elbow falls below this arc despite nonoperative care, open arthrolysis with HO excision becomes indicated. Nonoperative splinting and mobilization work best within the first 6 months while the heterotopic bone is still maturing.
Two technical points drive board questions and real outcomes. First, always address the ulnar nerve: improved flexion after release stretches the nerve and raises intraneural pressure, so routine neurolysis with anterior transposition (decompression ≥7 cm) prevents the most common complication.
Second, preserve the anterior bundle of the MCL and the lateral ulnar collateral ligament to avoid iatrogenic instability. Remember that poor neurological recovery or cognitive dysfunction is a contraindication, since these patients cannot participate in the rigorous rehab that preserves the arc gained in surgery.
The timing debate has shifted: early excision under 1 year is now considered safe once HO is radiographically mature.
This is a team-based review of posttraumatic elbow contracture caused by heterotopic ossification. It walks through diagnosis, nonoperative management, open arthrolysis with HO excision, and structured rehabilitation. The roles of the orthopaedic surgeon and physical therapist are laid out at each stage of care.
Anchor every treatment decision to the functional arc: 100° of flexion (30° to 130°) and 100° of rotation. When a posttraumatic elbow falls below this arc despite nonoperative care, open arthrolysis with HO excision becomes indicated. Nonoperative splinting and mobilization work best within the first 6 months while the heterotopic bone is still maturing.
Two technical points drive board questions and real outcomes. First, always address the ulnar nerve: improved flexion after release stretches the nerve and raises intraneural pressure, so routine neurolysis with anterior transposition (decompression ≥7 cm) prevents the most common complication.
Second, preserve the anterior bundle of the MCL and the lateral ulnar collateral ligament to avoid iatrogenic instability. Remember that poor neurological recovery or cognitive dysfunction is a contraindication, since these patients cannot participate in the rigorous rehab that preserves the arc gained in surgery.
The timing debate has shifted: early excision under 1 year is now considered safe once HO is radiographically mature.