Prevention of Post Traumatic Radioulnar Heterotopic Ossification Recurrence Using Acellular Human Dermal Matrix: A Case Report and Review of Literature

Abstract

Post-traumatic radioulnar synostosis is a challenging condition to treat due to its rarity and high recurrence rate. It represents only 2% of all distal forearm injuries. It is complicated by significant impairment of function due to restricted wrist pronation and supination. Risk factors include open fractures, severe soft tissues injury and high energy injuries. Physical therapy can help improve the function of the wrist, but it may not always prevent the recurrence of synostosis. We describe the successful treatment of a patient with distal radioulnar heterotopic ossification using the human ADM. ADM interposition is a new technique for the treatment of distal radioulnar heterotopic ossification. After heterotopic ossification resection, ADM is inserted between the radius and ulna in a cigar-shaped construct. Patients are monitored clinically and radiographically. We treated 1 female patient with recurrence of heterotopic ossification. The range of motion in supination and pronation of the affected wrist improved significantly postoperatively, at the 12 weeks follow up. No postoperative complications occurred and there was no recurrence. The ADM provides a barrier between the radius and ulna to prevent reformation of heterotopic ossification. The use of ADM results in no morbidity at the harvest site and is theoretically more resistant to infection compared to non-biologic barriers such as silicone and Integra. This technique is a simple, safe and effective procedure to treat and prevent the recurrence of heterotopic ossification at the radioulnar joint.