ICYMI: A New Approach to Beating Heterotopic Ossification in Elbow Trauma Surgery — What Now?

A CORRelations post turned into a pearl for my practice

I found the CORRelations post “ICYMI: A New Approach to Beating Heterotopic Ossification in Elbow Trauma Surgery” both fascinating and practice-changing. It describes the off-label use of tranexamic acid (TXA) in prophylaxis against heterotopic ossification after severe elbow trauma and it’s worth putting to use in your practice.

Many of us routinely use TXA during larger procedures — some fractures and, certainly, arthroplasty surgery — to decrease blood loss. It’s safe, effective (numerous meta-analyses substantiate this), and widely available. The AAOS’s Clinical Practice Guideline gave TXA its highest recommendation in the context of treating patients with hip fractures.

Just recently, I was performing a closed manipulation on a patient with arthrofibrosis after a severe distal humeral fracture and I remembered the CORRelations post on this topic pertaining to preventing heterotopic ossification in elbow trauma; I gave the patient TXA, as I now routinely do to all my patients with severe elbow trauma.

Patients who develop severe elbow heterotopic ossification don’t care how perfectly you reduced and stabilized the fracture if the elbow is too stiff to move.

Next time you treat someone with a tough elbow fracture, keep this pearl in mind and think about giving TXA.