Heterotopic ossification following severe radial head fractures: Clinical outcome and associated factors
Cornelius Sebastian Fischer1
, Johannes Porsche1, Diane Leyder1, Daniel Schüll1, Tina Histing1, Patrick Ziegler1,2
1Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
2Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland
Keywords: Clinical outcome, elbow, heterotopic ossification, Mason-Johnston injury types 3 and 4, radial head fractures, range of motion.
Abstract
Objectives: This study aimed to evaluate clinical outcome, prevalence, severity, location, range of motion, and possible risk factors of heterotopic ossification (HO) following severe radial head fractures.
Patients and methods: In this retrospective study, 73 patients (40 males, 33 females; mean age: 51.4±15 years; range, 20 to 82 years) with Mason-Johnston type 3 and 4 radial head fractures were surgically treated with osteosynthesis or radial head arthroplasty (RHA) between September 2014 and February 2021. Fifty-one were examined in person, while 22 participated via questionnaire. The clinical outcome was assessed by the range of motion, the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and the 36-item ShortForm Health Survey (SF-36). Operative and postoperative details and the intake of HO prophylaxis were reviewed. Heterotopic ossification severity and location was evaluated on radiographs.
Results: Heterotopic ossification was present in 52.1%, while in 31.5% of all participants, RHA was needed. Overall, 46.6% received additional ligamental refixation. The mean time to surgery was 8.9±11.9 days, and the mean DASH was 13.7±16.6. In patients treated with osteosynthesis, more HO was observed for MasonJohnston type 4 injuries compared to Mason-Johnston type 3 injuries (p=0.028). Overall, more HO was present in Mason-Johnston type 4 injuries (63.6%) compared to Mason-Johnston type 3 injuries (42.5%), without reaching significance (p=0.072). No significant association between HO and time to surgery (p=0.716), implantation of RHA (p=0.127), or ligamental refixation (p=0.121) was detected. Regardless of intake of HO prophylaxis, nearly the same amount of HO (51.7% vs. 53.8%) was present. No differences between the HO and non-HO group were detected in the DASH (p=0.553) and the SF-36 (physical component, p=0.728; mental component, p=0.275).
Conclusion: Over 50% surgically treated radial head fractures classified as Mason-Johnston types 3 and 4 developed HO, while more severe injuries led to a higher prevalence of HO. No increased rates of HO were determined for delayed surgery, surgical treatment methods, and use of HO prophylaxis. Therefore, regular HO prophylaxis might not be needed. Additionally, no significant differences in functional scores and quality of life were detected between patients with and without HO.
Citation: Fischer CS, Porsche J, Leyder D, Schüll D, Histing T, Ziegler P. Heterotopic ossification following severe radial head fractures: Clinical outcome and associated factors. Jt Dis Relat Surg 2025;36(1):47-55. doi: 10.52312/jdrs.2025.1992.
C.F. and P.Z. conceptualized and designed the study. C.F. was responsible for drafting the scientific subsumption. J.P. conducted all measurements and performed the statistical analyses. D.L., T., and D.S. contributed by providing critical advice on the study design. All authors revised and approved the manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.