Radiation therapy for heterotopic ossification prophylaxis acutely after elbow trauma: a prospective randomized study.

BACKGROUND: Heterotopic ossification around the elbow can result in pain, loss of motion, and impaired function. We hypothesized that a single dose of radiation therapy could be administered safely and acutely after elbow trauma, could decrease the number of elbows that would require surgical excision of heterotopic ossification, and might improve clinical results. METHODS: A prospective randomized study was conducted at three medical centers. Patients with an intra-articular distal humeral fracture or a fracture-dislocation of the elbow with proximal radial and/or ulnar fractures were enrolled. Patients were randomized to receive either single-fraction radiation therapy of 700 cGy immediately postoperatively (within seventy-two hours) or nothing (the control group). Clinical and radiographic assessment was performed at six weeks, three months, and six months postoperatively. All adverse events and complications were documented prospectively. RESULTS: This study was terminated prior to completion because of an unacceptably high number of adverse events reported in the treatment group. Data were available on forty-five of the forty-eight patients enrolled in this study. When the rate of complications was investigated, a significant difference was detected in the frequency of nonunion between the groups. Of the nine patients who had a nonunion, eight were in the treatment group. The nonunion rate was 38% (eight) of twenty-one patients in the treatment group, which was significantly different from the rate of 4% (one) of twenty-four patients in the control group (p = 0.007). There were no significant differences between the groups with regard to the prevalence of heterotopic ossification, postoperative range of motion, or Mayo Elbow Performance Score noted at the time of study termination. CONCLUSIONS: This study demonstrated that postoperative single-fraction radiation therapy, when used acutely after elbow trauma for prophylaxis against heterotopic ossification, may play a role in increasing the rate of nonunion at the site of the fracture or an olecranon osteotomy. The clinical efficacy of radiation therapy could not be determined on the basis of the sample size. Further research is needed to determine the role of limited-field radiation for prophylaxis against heterotopic ossification after elbow trauma.

Incidental neoplasm in iliac crest autograft procured for anterior cervical fusion.

STUDY DESIGN: A case report is presented. OBJECTIVE: To present a previously unreported complication of procuring anterior iliac crest autograft. SUMMARY OF BACKGROUND DATA: Many complications that involve the common procedure of procuring iliac crest autograft have been reported and studied. The incidental finding of a neoplasm in an iliac crest autograft in an otherwise asymptomatic patient has not been reported previously. METHODS: A case of benign fibrous histiocytoma is presented as it was found incidentally during the procurement of the anterior iliac crest for anterior cervical fusion. Intraoperative decision making and alternatives for this challenging situation are reviewed. RESULTS: An iliac crest bone graft with a grossly unusual appearance was noted at the time of autograft procurement. The autograft was aborted, and an iliac crest allograft was substituted for the autograft to complete the planned cervical fusion. The lesion was later identified histopathologically and clinically as a benign fibrous histiocytoma. Postoperative computed tomography demonstrated the extent of the lesion. CONCLUSIONS: The intraoperative finding of a bony neoplasm at a planned autograft donor site in an otherwise healthy patient supports routine preoperative discussion of allograft alternatives. All patients undergoing surgery in which autograft is to be used should be informed regarding the possibility of allograft substitution. When a neoplasm is encountered unexpectedly, oncologic principles of obtaining frozen section or a touch-prep for diagnosis, avoiding the use of suspect graft material as well as cross-contamination of iliac crest and anterior cervical surgical sites, should be applied. Care should be taken intraoperatively with potentially contaminated drapes and instruments.