Heterotopic ossification (HO) resulting in radioulnar cross-union occurs in approximately
2% of all forearm injuries and causes significant functional impairment. Risk factors
for cross-union are incompletely understood, however, injuries to the proximal forearm
account for the majority of cases. Concomitant central nervous system injury greatly
increases the risk for HO after forearm fracture. Although surgical excision of forearm
cross-union has produced mixed results in the past, and recurrence of synostosis has
been common, more recent treatment attempts have resulted in nearly full recovery
of forearm rotation. Questions remain regarding the appropriate timing for excision
and the advisability of adjuvant low-dose radiotherapy to prevent recurrence. It would
seem that HO resulting from local trauma in the absence of other risk factors can
be safely excised 6 to 12 months after injury. Adjuvant radiotherapy may be warranted
in more aggressive cases of HO with a greater risk for recurrence, such as those cases
involving the proximal forearm or associated with closed head injury.
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© 2005 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
