Radiation therapy for prevention of heterotopic ossification about the elbow

To evaluate the radiologic and functional outcome after prophylactic radiation therapy (RT) for prevention of heterotopic ossification (HO) about the elbow joint.

20 patients with symptomatic HO were treated using perioperative single-dose RT of 7.0 Gy. 15 patients had excision of preexisting functionally relevant HO, and received RT for prevention of a recurrence, and five patients were treated prophylactically because of risk factors. In 13 patients RT was applied within 5 h preoperatively, seven patients received postoperative RT. The local control was evaluated by plain radiographs and the functional outcome was assessed by use of the Mayo Elbow Performance Score (MEPS).

After a mean follow-up of 43.3 months, two patients had recurrence of the HO and were treated with further surgical resection. In the remaining 18 patients no progression of the HO was observed. At follow-up, the MEPS varied from 45 to 100 with 13 patients having no functional impairment (MEPS 100). Five patients experienced a slight limitation of the elbow with an MEPS ranging from 75 to 95, and only two had persistence of marked impairment with an MEPS of 45 and 50, respectively. Adverse effects related to use of RT were observed in none of the treated cases.

Pre- or postoperative RT is effective for prevention of HO about the elbow joint and can be recommended as an integral component of interdisciplinary treatment in complicated elbow fractures. At this, the use of MEPS has proven to be a feasible method for evaluation of the functional outcome.