Farzan Jessica J, Johal Ovninder, Jao Brian, Rothkopf Douglas M
From the Plastic Surgery Department, UMass Chan Medical School, Worcester, MA.
Plast Reconstr Surg Glob Open. 2025 Mar 24;13(3):e6661. doi: 10.1097/GOX.0000000000006661. eCollection 2025 Mar.
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.
创伤后桡尺远侧关节异位骨化（DRU HO）是一种罕见病症，其特征为桡骨和尺骨之间形成骨组织，导致旋前旋后功能受损。建议的治疗技术包括物理治疗、放射治疗、药物治疗、有限切除、骨切除术和关节融合术。然而，由于持续存在和复发率高，尚无单一技术成为标准治疗方法。一些作者描述了使用自体间置移植或放置尸体阔筋膜张肌，但这些方法分别与供区并发症和获取困难有关。我们报告了在一名21岁男性患者中应用人脱细胞真皮基质（ADM）作为间置材料治疗创伤后DRU HO的情况。该患者在摩托车碰撞后发生桡骨远端和尺骨移位骨折，接受了切开复位内固定治疗以及掌侧前臂筋膜切开术。初始治疗后，患者出现僵硬和不适。影像学检查显示严重骨化，促使进行切除并放置ADM。术后，患者有显著改善，旋后达90度、旋前达70度，几乎恢复了完全活动，11个月后无并发症或复发。这是第三例使用ADM间置材料成功治疗的病例，进一步证明了其作为创伤后DRU HO简单且持久治疗选择的有效性。与其他技术相比，ADM具有诸多优势，包括无供区并发症、成本低且易于获取，使其成为一种安全有效的替代方法。
