Hypothesis and BackgroundHeterotopic ossification (HO) is a recognised complication following operative fixation of elbow trauma.While indomethacin prophylaxis is well established in hip and acetabular surgery, evidence for its role in elbow injuries remains limited.This randomised controlled trial (RCT) evaluated whether oral indomethacin reduces the incidence and severity of HO after surgical treatment of acute elbow fractures and dislocations. MethodsEighty-six adults with acute elbow injuries requiring surgical fixation were randomised 1:1 to receive either oral indomethacin (25 mg three times daily for three weeks) or no prophylaxis.Eighty-four patients completed follow-up.HO was assessed radiographically at scheduled intervals through the final follow-up and graded using the Hastings and Graham system.The Mantel-Haenszel method was used to calculate a pooled odds ratio adjusted for injury severity. ResultsHO developed in 21 of 84 patients (25%), occurring in 14.3% of the indomethacin group versus 35.7% of controls (p = 0.018), with indomethacin reducing both incidence (absolute risk reduction 21.4%; NNT = 5) and severity (mean grade 1.33 vs 2.93, p = 0.013).All HO in the indomethacin group were low grade (G1-G2A), whereas high-grade HO (G2C-G3) occurred in 8 of 15 (53.3%) control patients.Stratified analysis demonstrated consistent trends across injury severity levels, with Mantel-Haenszel adjustment yielding similar estimates.Patients with HO in the indomethacin group had a greater range of motion compared to controls. J o u r n a l P r e -p r o o fIndomethacin Prevents Severe Elbow HO Discussion and ConclusionIndomethacin prophylaxis was associated with reduced incidence and severity of HO following operative fixation of elbow injuries.These findings should be interpreted in the context of baseline differences in injury severity between groups.Indomethacin may be a useful adjunct in patients at risk of HO following elbow trauma given its low cost, ease of administration and favourable safety profile, although further multicentre studies are required.
C et al. (Fri,) studied this question.