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Background: Heterotopic ossification (HO) is reported to occur in 0.1-3.3% of elbows after a severe burn, and can significantly limit elbow motion and upper extremity function., Methods: The study included 9 patients (11 elbows) treated by the senior author (TW). The surgical technique consisted of making multiple small surgical approaches to remove heterotopic ossification (without raising cutaneous flaps) and concomitantly releasing the elbow capsule and skin contracture. Perioperative radiation therapy was performed to decrease heterotopic ossification recurrence. Outcome measures included postoperative elbow range of motion and Mayo Elbow Performance Score., Results: The average amount of body surface area burned was 54% (range, 10-86%) and mean time from injury to elbow surgery was 416 days (range, 175-860). All elbows had some degree of direct involvement with the thermal injury. Preoperative arc of motion averaged 39° in flexion/extension and 78° in supination/pronation. Four elbows had complete ankylosis in the flexion/extension plane and 1 had only 5° of motion. At last follow-up, arc of motion in flexion/extension averaged 116° and 139° in supination/pronation, an improvement of 77° and 61°, respectively. One recurrence of HO required re-excision., Conclusion: We recommend this multiple-approach surgical technique for treatment of heterotopic ossification and elbow contracture after burn injury, along with perioperative radiation therapy to decrease recurrence. Our surgical approach and treatment resulted in significant gains in elbow motion and upper extremity function with few complications., (Copyright © 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.)

Treatment of the stiff elbow by arthroscopic capsular release is a relatively new and effective procedure. The surgery is technically demanding and is not indicated in all cases of stiff elbow. Although neurologic complications are unusual, they can be severe and permanent. Neurologic structures at particular risk are the posterior interosseous and ulnar nerves. Rehabilitation is as important as the surgical procedure itself. Arthroscopic capsular release is particularly effective in elbows with minor flexion contractures (less than 30 degrees) and might have some advantages over an open procedure for these minor contractures.

Proximal ulna fractures are relatively common. They range in severity from a simple transverse olecranon fracture to a highly complex fracture dislocation involving a comminuted coronoid process. The anatomy, fracture pathology, treatment approach, and rehabilitation are presented in this article.

The fixation of displaced greater tuberosity fractures with 5-0 Fiberwire, Fiberwire tape, and 5-0 Ethibond sutures was compared in 12 pairs of cadaveric humeri. A simulated fracture was created and fixed with suture in a figure-of-eight pattern. The tuberosity was cyclically loaded and its displacement measured. There was no statistical difference in fixation stability between the three suture types.