Resection of elbow ossification and continuous passive motion in postcomatose patients

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.