Elbow Heterotopic Ossifications Associated With Radial Head Prosthesis

Study Overview
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Brief Summary
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Elbow heterotopic ossification (EHO) is described as the formation of ectopic bone in tissues not supposed to around elbow. The EHO physiopathology, yet not clarified, has been suggested to be a multifactorial process in which immune system, inflammatory response, CNS and tissue expressed proteins after severe trauma boost hyperactive metabolically bone with no periosteal layer. Consistent with that, EHO has been widely related to elbow trauma, including bone, ligament, muscle or joint; iatrogenic trauma, including epicondylectomy or elbow arthroplasty; neural injuries or burns. Clinical manifestations of EHO has been reported as limited range of motion (ROM), muscle, nerve or joint pain, stiffness and ankylosis all of them leading to upper extremity disfucntion. Prevalence of EHO can range from 3%-45% depending on degree of elbow injury. To our knowledge, prevalence of EHO among radial head fractures had not been assessed previously.

Detailed Description
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Prevention of EHO has been proposed to be managed with a range of nonsurgical treatment options such as: radiotherapy, NSAIDS and biphosphonate. However, none of them had become clear effective above others, and only surgical excision of EHO had become a reliable option to overcome its associated limitations in elbow motion. Classic approaches suggested delayed surgery until maturity of heterotopic bone, however recent literature suggest early excisions of immature ossification to obtain favorable functional results. Several studies have investigated risk factors of EHO regarding the high patient burden and health costs to which is associated, however, few published data exists about prevalence and risk factors of EHO after radial head arthroplasty. Our aim is to assess the prevalence and predictor factors that can lead to EHO after radial arthroplasty in order to be able to predict and apply early preventive treatment to improve postoperative functional outcomes among patients with severe radial head fractures.

Official Title
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Elbow Heterotopic Ossifications Associated With Radial Head Prosthesis: Risk and Prognostic Factors

Conditions
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Radial Head Fracture

Intervention / Treatment
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* Procedure: Radial head prosthesis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults between 18-85 years-old Comminuted radial head fractures treated with radial head arthroplasty Exclusion Criteria: Younger than 18 years; Older than 85 years History of previous elbow injuries or operations. Pathologic fractures Infections

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Radial head prosthesis|Radial head arthroplasty in comminuted radial head fractures.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prevalence of EHO | Assess prevalence of EHO after radial head arthroplasty in anteroposterior and lateral radiographs. | 12 months | 
| Average size of EHO | Size of EHO (measure in mm) in X-rays. | 12 months | 
| Site of EHO in elbow | Location of EHO in elbow anteroposterior and lateral X-rays (anterior, posterior, medial, lateral). | 12 months | 
| Osteopenia of the capitellum | The radiographs of the elbow will be review for osteopenia of the capitellum, and graded as none, mild, moderate, or severe according to the system of Lamas et al. (2011). | 12 months | 
| Degenerative changes of the elbow | In anteroposterior and lateral X-rays. For the degree of degenerative change of the elbow, classified as Grade 0 (normal joint), Grade 1 (slight joint, space narrowing and minimum osteophyte formation), Grade 2 (moderate joint space narrowing and moderate osteophyte formation), or Grade 3 (severe degenerative changes with gross destruction of the joint) according to the system of Broberg and Morrey (1986). | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Radial head fracture and associated elbow lesions | We classified the radial head fracture by Mason´s classification with the Johnston modification (Fracture types I, II, III, IV) (1954). | 12 months |