CASE REPORT Operative treatment of anterior heterotopic bone formation of the elbow in a patient with severe haemophilia A S. M. J. MORTAZAVI, S. ASADOLLAHI and M. MOTAMEDI Imam Hospital Haemophilia Centre, Tehran University of Medical Sciences, Tehran, Iran Summary. There is no statistical data on the inci- dence of heterotopic ossification among patients with haemophilia, and a few reports documenting this entity in haemophilia are available. Although post- traumatic heterotopic ossification about the elbow is a well-recognized complication, we are not aware of any previously reported case in haemophiliacs. An 8-year-old boy with severe haemophilia A presented with fixed elbow in 80° of flexion. Radiographs disclosed a mature anterior heterotopic ossification in the form of complete ulnohumeral bony bridge. Surgical excision of the heterotopic bone was per- formed. A full elbow range of motion was obtained after long-term physiotherapy. We conclude that this surgery is safe and successful in haemophilic patients, if performed at the right time under optimal situ- ation. Keywords: elbow, haemophilia, heterotopic bone formation, surgical treatment Introduction The true incidence and evolution of heterotopic ossification among patients with haemophilia has not been delineated yet [1]. Contrary to bleeding diathe- sis seen in patients suffering from haemophilia and a relatively frequent incidence of intra-muscular hae- matomas, heterotopic bone formation seems not to be a common condition in this group of patients [2]. Few case reports have addressed this entity in English language literature, most of them being instances of heterotopic bone formation around pelvis [1–6]. We present a rare case of heterotopic ossification around the elbow in the form of complete bony bridge. To our knowledge, this site of involvement has not been reported previously. Case report An 8-year-old boy with severe (<1%) haemophilia (factor VIII deficiency) referred to our clinic com- plaining of severe elbow dysfunction with limited range of motion. There was no history of an inhibitor. The serological tests for blood-borne viral infection were also negative. He sustained a trauma to the left elbow and subsequent swelling and haemarthrosis 16 months before admission. Initial treatment included factor replacement and immobi- lization and analgesics. The swelling and haemar- throsis subsided; however, the elbow range of motion did not improve by time in spite of active and active-assisted physical therapy. Physical exam- ination revealed a painless stiff elbow without any range of motion that was fixed in 80° of flexion (Fig. 1). A bony mass could be palpated on the anterior aspect of the elbow. The neurovascular examination was normal. Plain radiographs showed an anterior heterotopic ossification as complete ulnohumeral bony bridge (Fig. 2a,b). The serum erythrocyte sedimentation rate and alkaline phopha- tase were also within normal ranges. Operative excision of heterotopic bone was considered. Through an anteromedial approach, neurovascular bundle was explored and put away medially. The lesion was found in the bulk of brachialis, and completely excised (Fig. 3). The postoperative period was uneventful. Active-assisted and active flexion and extension of the elbow began 2 days after surgery. Physiotherapy was continued for 3 months Correspondence: Dr Mortazavi, Department of Orthopedic Surgery, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tel.: +98 21 669 30041-9, ext: 2455; fax: +98 21 669 35512; e-mail: smjmort@yahoo.com; mortazsm@sina.tums.ac.ir Accepted after revision 13 April 2006 Haemophilia (2006), 12, 444–447 DOI: 10.1111/j.1365-2516.2006.01295.x 444 Ó 2006 Blackwell Publishing Ltd