The Use of Acellular Dermal Matrix for the Treatment of Posttraumatic Radioulnar Heterotopic Ossification.

Abstract

Posttraumatic distal radioulnar heterotopic ossification (DRU HO) is a rare condition characterized by impaired pronosupination due to bone formation between the radius and ulna. Proposed management techniques have included physical therapy, radiation, medication, limited resection, ostectomy, and arthrodesis. However, no single technique has emerged as the standard of care due to high rates of persistence and recurrence. Some authors have described the use of autologous interposition grafting or the placement of cadaveric tensor fasciae latae, but these methods are associated with donor-site morbidity and difficulty with availability, respectively. We report the application of human acellular dermal matrix (ADM) as an interposition material for the treatment of posttraumatic DRU HO in a 21-year-old male patient. The patient sustained displaced distal radius and ulnar fractures following a motorcycle collision, which were treated with open reduction and internal fixation, along with volar forearm fasciotomy. After the initial treatment, the patient developed stiffness and discomfort. Imaging revealed severe ossification, prompting resection and ADM placement. Postsurgery, the patient experienced significant improvement, achieving nearly full motion with 90 degrees of supination and 70 degrees of pronation, with no complications or recurrence after 11 months. This is the third case of successful treatment with ADM interposition material, adding to evidence for its use as a simple and durable option for posttraumatic DRU HO. ADM offers numerous benefits over other techniques, including no donor-site morbidity, low cost, and wide availability, making it a safe and effective alternative.