Comparing Options for Heterotopic Ossification Prophylaxis following Elbow Trauma: A Systematic Review and Meta-Analysis

Jeffrey M. Henstenburg; Matthew Sherman; Asif M. Ilyas

doi:10.1055/s-0040-1721880

Journal of Hand and Microsurgery, Table of Contents

J Hand Microsurg 2021; 13(03): 189-195
DOI: 10.1055/s-0040-1721880

Survey or Meta-Analysis

Comparing Options for Heterotopic Ossification Prophylaxis following Elbow Trauma: A Systematic Review and Meta-Analysis

Authors

Jeffrey M. Henstenburg

¹Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Matthew Sherman

¹Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Asif M. Ilyas

¹Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, United States

Subject Editor:

Abstract

Introduction Heterotopic ossification (HO) can be a potentially serious and devastating complication following traumatic injury to the elbow. HO prophylaxis options include nonsteroidal anti-inflammatory drugs (NSAIDs) and radiation therapy (RT) but neither has been proven more effective. The purpose of this review is to compare effectiveness and outcomes between NSAID and RT prophylaxis for HO about the elbow following a traumatic injury.

Materials and Methods We performed a systematic review of PubMed and Cochrane Library for cases of HO prophylaxis following elbow trauma utilizing PRISMA guidelines to determine the most effective form of prophylaxis. Outcomes of interest included recurrence of HO, range of motion (ROM), and Mayo elbow performance index (MEPI). A total of 36 articles and 826 elbows of which 203 received RT and 623 received NSAID were identified and included in the final analysis.

Results Rates of HO formation or recurrence following elbow trauma were similar between radiation and NSAID prophylaxis (15.6% vs. 22.2%, respectively p = 0.457). ROM was similar in flexion and extension arc (109.0 degrees in radiation vs. 112.8 in NSAIDs, p = 0.459) and in pronation and supination arc (118.9 degrees radiation vs. 134.7 degrees NSAIDs, p = 0.322). MEPI scores were 79.19 in the radiation group and 88.82 in the NSAIDs group at the final follow-up.

Conclusion There is no statistical difference in HO development, recurrence, or final ROM between NSAIDs and RT prophylaxis following trauma to the elbow. We recommend the choice of modality based on patient characteristics, cost, and surgeon preference.

Level of Evidence Level III.

Keywords

elbow - trauma - heterotopic ossification - prophylaxis - radiation therapy - NSAID - review

Full Text

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