Heterotopic periarticular ossifications were surgically excised in 16 elbows of 14 traumatic brain injury patients an average of 18.9 months (range, 4-67 months) after the end of coma. In 11 elbows the ulnohumeral joint was ankylosed in a position that ranged from 0°to 100°of flexion (group 1); in 5 elbows the arc of flexion ranged from 10°to 25°(group 2). Full pronation and supination were present in 15 of the elbows; in 1 the radiocapitellar joint was fixed at 30°of pronation by a partial ossification of the interosseous membrane. The arc of flexion attained after surgery averaged 115°(range, 90°to 145°) in the group 1 elbows and 128°(range, 115°to 140°) in the group 2 elbows. In an attempt to prevent postoperative loss of motion and recurrence of ossification, continuous passive motion was applied to the affected elbow for 6 weeks before starting a fully active rehabilitation program. All the patients were examined at regular intervals after the surgery. The follow-up period ranged from 12 to 60 months (average, 30.7 months). During the follow-up period, all the elbows showed improvement in range of motion and the arc of flexion averaged 95°(range, 30°to 135°) in the group 1 elbows and 116°(range, 80°to 145°) in the group 2 elbows. Patients with poor neuromuscular control lost part of their postoperative range of motion and partial recurrence was observed in 3 elbows. We believe that our improved results, compared with those obtained by previous investigators, may have been due to the prolonged application of continuous passive motion after surgery.
- Continuous passive motion
- Heterotopic ossification
- Surgical treatment
ASJC Scopus subject areas
- Orthopedics and Sports Medicine