Review Question - QID 4881

This patient has elbow stiffness caused by posteromedial heterotopic ossification after healing of his distal humerus fracture.

Stiffness and limited range of motion is common secondary to extrinsic causes. Studies have shown operative treatment via HO excision, capsular release, and/or release of the posterior band of the UCL can improve range of motion.

Park et al. studied 42 patients with extrinsic contracture of less than 100 degrees. They report posteromedial HO excision with capsular release and release of the posterior band of the UCL significantly improved ROM.

Williams et al. studied 164 patients who underwent release for extrinsic tightness with ulnar nerve decompression for preoperative symptoms. Following decompression, low rates of postoperative ulnar nerve symptoms were noted. More post-operative symptoms were seen for more severe contractures.

Figure A is an AP and lateral radiograph of the elbow with posteromedial heterotopic ossification. Figure B is a 3D CT reconstruction confirming the posteromedial location.

Incorrect Answers:
Answer 1. There is a mechanical block to motion. Continued therapy will not improve the patient's range of motion.
Answer 2. Indomethacin is used for heterotopic ossification prophylaxis.
Answer 3. Radiation therapy is used for heterotopic ossification prophylaxis.
Answer 5. The anterior band of the ulnar collateral ligament should not be released because it will cause secondary valgus instability.