Radiographic Changes in Burns of the Upper Extremity

Schiele, Howard P.; Hubbard, Robert B.; Bruck, H

doi:10.1148/104.1.13

Cited by 22 publications

(3 citation statements)

References 5 publications

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“…If surgery was performed before scar maturation, HO was noted to continue to form. 4 Schiele et al 16 prospectively obtained weekly plain elbow x-rays in patients with upper extremity burns admitted during a 1-year period. HO was identified on routine plain x-rays before clinical symptoms appeared.…”

Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification Revisited: A 21-Year Surgical Experience

Hunt

Arnoldo

Kowalske

et al. 2006

Journal of Burn Care & Research

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Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.

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Section: Discussionmentioning

confidence: 99%

Heterotopic Ossification Revisited: A 21-Year Surgical Experience

Hunt

Arnoldo

Kowalske

et al. 2006

Journal of Burn Care & Research

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“…Intraarticular bony ankylosis is a rare complication of severe burns of the hand (1,2). This is in contrast to the more typical presentation of joint ankylosis found in association with extraarticular heterotopic ossification (1,3,4). Interphalangeal joint injury results from direct thermal insult or burn-related infection, and bony ankylosis follows as a long-term consequence of articular destruction.…”

Section: Discussionmentioning

confidence: 99%

Case 229: Burn-related Global Ankylosis of Interphalangeal Joints with Associated Acroosteolysis

Davis¹,

Resnik²

2016

Radiology

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History A 50-year-old woman presented with a 6-month history of polyarthralgia involving the left and right hands, wrists, elbows, ankles, and knees. Her pain was not associated with morning stiffness but did worsen over the course of the day. She denied experiencing fevers, chills, or mouth ulcers. She did not report paresthesias or blue discoloration of her fingers when they were exposed to cold. Her family history was remarkable for an aunt who died of systemic lupus erythematosus and for a brother with arthritis. Her medical history was remarkable for vitamin D deficiency, hypertension, and rehabilitation for burns. At clinical examination, she had mild tenderness to palpation of her joints, without associated erythema, swelling, or crepitus. Healed skin grafts were also noted. Blood chemistry tests revealed a rheumatoid factor of 8.5 IU/mL (normal range, 0-13.9 IU/mL), an erythrocyte sedimentation rate of 2 mm/hr (normal range, 0-40 mm/hr), and a C-reactive protein value of 0.4 mg/L (3.8 nmol/L) (normal range, 0-4.9 mg/L [0-46.7 nmol/L]). Antinuclear antibodies test results were negative. Radiography of the right and left hands was performed.

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“…The most commonly cited aetiology of heterotopic bone formation in burn patients is prolonged immobilisation and trauma associated with aggressive physical therapy [1] . Immobilisation of the elbow and bed rest have, however, not been shown to be statistically signifi cant factors for the incidence of heterotopic calcifi cation at the elbow [6,12,13] . Trauma to the joint from the initial injury or possibly during the patient ' s rehabilitation has been implicated but never proven to be a contributory factor [8] .…”

Section: Heterotopic Para-articular Ossifi Cation In a Child Followinmentioning

confidence: 96%