Ulnar nerve compression at the elbow secondary to burn related heterotopic ossification – a case report and literature review of management options
Published Date: 04th May 2022
Publication Authors: Ramadan S, Cappuyns L, Shokrollahi K, Gurusinghe D
Poster presentation for the BBA Annual Meeting, May 2022. Full conference programme available here: https://www.britishburnassociation.org/wp-content/uploads/2018/04/BBA-Bristol-4-6.5.22-Full-Programme-.pdf
Introduction
Heterotopic ossification (HO) is a poorly understood pathological process which can complicate the management of burns. It is thought to be mediated by tissue hypoxia amongst other factors and involves the deposition of lamellar bone around joints and in soft tissues resulting in debilitating pain, decreased range of motion (ROM), loss of function, increased length of hospital stay and, rarely, nerve entrapment. HO is a relatively rare occurrence affecting 0.2-4% of burn patients. The most commonly-affected sites are the elbows, with other joints including shoulders, hips and knees affected to a lesser extent. There is no consensus regarding the timing of management and treatment. Intervention, if considered at all, is often delayed until maturation of the process for fear of recurrence or exacerbation. We describe a rarely reported case of ulnar nerve entrapment at the elbow secondary to HO following a burn injury and its necessary, early treatment.
Aims
- To outline our early intervention treatment strategy which resulted in a successful outcome.
- To synthesise evidence from the literature on treatment approaches for HO following acute burns, with reference to rare instances of nerve entrapment in particular.
Conclusion
Our early surgical approach to HO associated nerve entrapment, enhanced with adjuvant pharmacotherapy and aggressive physiotherapy, resulted in a good outcome with no signs of recurrence at 2+ years. More research is needed to understand the pathophysiology of the disease process and to guide prevention and management of HO. In the meantime, we highlight the successful, early management of a neurologically symptomatic patient with a multimodal approach of early surgical intervention with adjuvant pharmacotherapy and physiotherapy perioperatively.
Ramadan, S; Cappuyns, L; Bastouros, E; Shokrollahi, K; Gurusinghe, D. (2022). Ulnar nerve compression at the elbow secondary to burn related heterotopic ossification – a case report and literature review of management options. Conference poster from British Burns Association Annual Meeting, 4th-6th May 2022.
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