Heterotopic ossification after severe burns: a report of three cases and review of the literature

Richards, Adrian; Klaassen, Michael F.

doi:10.1016/s0305-4179(96)00074-5

Cited by 43 publications

(36 citation statements)

References 32 publications

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“…The elbow was the most frequent site of excision of HO (39 patients) followed by hip (2), and forearm (1). ( Figure 1A and 1B) Although 17 patients had evidence of HO in another joint, 16 in the elbow and 1 in the hip, only 5 patients had HO surgically excised from 2 joints (1 hip and 4 elbows).…”

Section: Resultsmentioning

confidence: 99%

“…Surgical excision of HO was performed before complete scar maturation if: 1) the patient's ROM decreased to the point of compromising ADL (17 elbows); 2) the patient had symptoms of ulnar nerve entrapment (3 elbows); or 3) the patient was unable to perform physical therapy on an extremity with restrictive scar in the antecubital fossa because of HO in the elbow. 2 Surgery was delayed until scar maturation was complete (25 joints) if additional ROM would improve the patient's lifestyle. Hip HO was removed for the latter reason.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5] The development of HO is insidious, most often recognized late after the burn injury, and results in significant impairment on activities of daily living (ADLs) in patients who may already be functionally handicapped by the burn. Members of the burn team should consider the diagnosis when decreased range of motion (ROM), not attributed to scar contracture, occurs in a burn patient.…”

Section: Mean Day Of Diagnosis Was 71 Days (Range 21-134) Excision mentioning

confidence: 99%

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Heterotopic Ossification Revisited: A 21-Year Surgical Experience

Hunt

Arnoldo

Kowalske

et al. 2006

Journal of Burn Care & Research

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Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Mean Day Of Diagnosis Was 71 Days (Range 21-134) Excision mentioning

confidence: 99%

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Heterotopic Ossification Revisited: A 21-Year Surgical Experience

Hunt

Arnoldo

Kowalske

et al. 2006

Journal of Burn Care & Research

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“…[1][2][3] The heterotopic ossification of muscles, tendons and ligaments can be a problem after musculoskeletal trauma, severe burns, neurologic injury, elective surgery and fibrodysplasia ossificans progressiva. [4][5][6][7][8][9][10][11][12][13][14] X-ray image revealed an incidence of 15-90% of heterotopic ossification in patients who received total hip arthroplasty in spite of preventive radiotherapy, with 1-27% of the patients reporting clinically important pain and loss of motion. 15 The incidence of burn-associated heterotopic ossification ranges between 1 and 3%, but can be as high as 35% for larger, more severe burns.…”

Section: Introductionmentioning

confidence: 99%

“…15 The incidence of burn-associated heterotopic ossification ranges between 1 and 3%, but can be as high as 35% for larger, more severe burns. 12,16,17 In patients with spinal cord injury, heterotopic ossification was reported to appear in 16-53% of patients, one-third of whom had clinically important manifestations. 18,19 Besides, heterotopic ossification was also reported in non-skeletal tissues such as the gastrointestinal tract.…”

Section: Introductionmentioning

confidence: 99%

Non-virus-mediated transfer of siRNAs against Runx2 and Smad4 inhibit heterotopic ossification in rats

et al. 2009

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Heterotopic ossification of muscles, tendons and ligaments are a common problem affecting patient with trauma or received elective surgery. But the existing preventive or therapeutic methods all have disadvantages. Runt-related protein 2 (Runx2) and Smad4 are two regulators that have important roles in the differentiation of osteoblast. In this study, we attempted to examine the effect of Runx2 and Smad4 on the development of heterotopic ossification in vitro. We constructed non-virus-containing small interference RNAs (siRNAs) against Runx2 and Smad4 and tested it with reverse transcriptase-PCR and western blot. We then analyzed the independent effect of Runx2-and Smad4-specific siRNAs and their cooperative effect on the formation of heterotopic ossification induced by trauma in rats. The effects were measured with computed tomography scanning, hematoxylin and eosin staining and immunohistochemistry. We found that the Runx2-and Smad4-specific siRNAs inhibited the expression of Runx2 and Smad4 at the level of messenger RNA and protein. Runx2 and Smad4 independently inhibited the formation of heterotopic ossification. Moreover, their co-expression significantly enhanced the inhibition of heterotopic ossification compared with the independent effect. We suggest that gene therapy to inhibit Runx2 and Smad4 by RNAi could be a powerful approach to prevent or treat heterotopic ossification.

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