A 14-year-old boy treated conservatively for a supracondylar humerus fracture returns 6 weeks later with a firm mass in front of the elbow, increasing stiffness, and restriction of flexion. Radiographs show soft tissue ossification anterior to the distal humerus. The MOST appropriate management now is:
- A Forceful passive stretching under anaesthesia to regain motion
- B Immediate surgical excision of the ossified mass
- C Gentle active-assisted range of motion exercises with avoidance of passive stretching and massage ✓
- D High-dose systemic corticosteroids
Correct answer: C. Gentle active-assisted range of motion exercises with avoidance of passive stretching and massage
Explanation
This is myositis ossificans traumatica, heterotopic bone formation within injured muscle, common around the elbow after supracondylar fractures or dislocations. Vigorous passive stretching, manipulation under anaesthesia and deep massage aggravate the injury and stimulate more ectopic bone, so they are contraindicated. Treatment is rest from provocation followed by gentle active-assisted movement. Excision, if ever needed, is deferred until the lesion matures, usually 6 to 12 months.
Reference: Apley's System of Orthopaedics and Fractures, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.