Ulnar Neuropathy Secondary to Posttraumatic Heterotopic Ossification of the Elbow

Neurological complications are quite rare following posttraumatic heterotopic ossification. A 10-year-old boy presented 6 weeks after a fall with stiffness in the right elbow. He was subjected to massaging and bandaging by a bone setter after the injury. There was clawing of the ring and little fingers along with muscle wasting. X-rays revealed a type III medial epicondyle fracture and heterotopic bone around the elbow. He had a 40° flexion deformity and limited extension. Heterotopic bone excision, neurolysis, anterior ulnar nerve transposition, and internal fixation of the fracture were done. Indomethacin was given for 3 weeks, and physiotherapy was started. At 6 weeks, clawing disappeared, and flexion improved to 95°, with a 10° extension restriction. After 3 months, flexion reached 110°, with no limitation of extension. The patient was followed for 3 years and had an excellent outcome with no residual deformity. A full neurological assessment for elbow injuries is crucial for early intervention.