Heterotopic Ossification After Surgery for Fractures and Fracture-Dislocations Involving the Proximal Aspect of the Radius or Ulna

Foruria, Antonio M.; Augustín, Salvador; Morrey, B.F.; Sánchez-Sotelo, Joaquín

doi:10.2106/jbjs.k.01533

Cited by 117 publications

(87 citation statements)

References 2 publications

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“…Previous studies [6,12,16], but not all [1,3], have also shown that dislocation correlates with restrictive HO. Complete ulnohumeral dislocation likely reflects greater soft tissue injury and a more severe injury, which in itself was identified as a predictor by Douglas et al [4].…”

Section: Repeat Irrigation and Débridement Of Deep Infectionmentioning

confidence: 84%

“…Recent publications have reported a prevalence in 7% to 20% of patients after surgically treated elbow trauma and assessed clinical predictors of HO restricting motion [1,3,6], but there is still uncertainty about the factors associated with development of restrictive HO after elbow injury. We determined whether any demographic, injury, or treatment factors were associated with the development of HO restricting motion after surgery for elbow trauma and how much of the variation in restrictive HO was explained by the variables studied.…”

Section: Discussionmentioning

confidence: 99%

“…Proposed risk factors for HO after elbow trauma based on relatively small case series include head trauma [7,8], spinal cord injury [7], fracture type [1], elbow dislocation [12,16], time from injury to surgery [3,4,6,12], and severe burn [5,11,13]. Although these factors have plausible predictive capacity, it remains uncertain how much of the variation in HO is explained with clinical factors.…”

Section: Introductionmentioning

confidence: 99%

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Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Wiggers

Helmerhorst

Brouwer

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is a common extrinsic cause of elbow stiffness after trauma. However, factors associated with the development of HO are incompletely understood. Questions/purposes We retrospectively identified (1) patient-related demographic factors, (2) injury-related factors, and (3) treatment-related factors associated with the development of HO severe enough to restrict motion after surgery for elbow trauma. We also determined what percentage of the variation in HO restricting motion was explained by the variables studied. Methods Between 2001 and 2007, we performed surgery on 417 adult patients for elbow fractures; of these, 284 (68%) were available for radiographs at a minimum of 4 months and clinical review at a minimum of 6 months after surgery (mean, 7.9 months; range, 6-31 months). HO was classified according to the Hastings and Graham system. Patients with HO restricting motion (defined as a Hastings and Graham Class II or III) were compared with patients without HO restricting motion in terms of demographics, fracture location, elbow dislocation, open wound, mechanism of injury, ipsilateral fracture, head trauma, time from injury to surgery, number of surgeries within 4 weeks, total number of surgeries, bone graft, and infection, using bivariate and multivariable analyses. A total of 96 patients had radiographic HO, and in 27 (10% of those available for followup), it restricted motion. Results There were no patient-related demographic factors that predicted the formation of symptomatic HO. Ulnohumeral dislocation in addition to fracture (odds ratio, 2.38; 95% CI, 1.01-5.64; p = 0.048) but not fracture location was associated with HO. Longer time from injury to definitive surgery and number of surgical procedures in the first 4 weeks were also independent predictors of HO (p = 0.01 and 0.004, respectively). These factors explained 20% of the variance in risk for HO restricting motion. Conclusions HO restricting motion after operative elbow fracture treatment associates with factors that seem related to injury complexity, in particular, ulnohumeral dislocation, delay, and number of early surgeries; however, a substantial portion of the variation among patients with elbow fracture who develop restrictive HO remains unexplained. Level of Evidence Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Section: Repeat Irrigation and Débridement Of Deep Infectionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Wiggers

Helmerhorst

Brouwer

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Heterotopic ossification (HO) is a frequent complication of musculoskeletal trauma after joint arthroplasty, hip and elbow fractures, and amputation [9,11,24,31]. Because traumatic brain injury is an additional risk factor for HO [7,14], high-energy wartime extremity injuries place warwounded patients at an increased risk of developing debilitating heterotopic lesions [10].…”

Section: Introductionmentioning

confidence: 99%

Botulinum Toxin-induced Muscle Paralysis Inhibits Heterotopic Bone Formation

Ausk

Gross

Bain

2015

Clinical Orthopaedics &Amp; Related Research

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Background Short-term muscle atrophy induced by botulinum toxin A (BTxA) has been observed to impair osteogenesis in a rat closed femur fracture model. However, it is unclear whether the underlying mechanism is a direct effect of BTxA on muscle-bone interactions or an indirect effect that is driven by skeletal unloading. Because skeletal trauma in the closed fracture model also leads to disuse atrophy, we sought to mitigate this confounding variable by examining BTxA effects on muscle-bone interactions in two complementary in vivo models in which osteogenesis is induced in the absence of skeletal unloading. The overall aim of this study was to identify a potential strategy to inhibit pathological bone formation and heterotopic ossification (HO). Questions/purposes (1) Does muscle paralysis inhibit periosteal osteogenesis induced by a transcortical defect? (2) Does muscle paralysis inhibit heterotopic bone formation stimulated by intramuscular bone morphogenetic protein (BMP) injection? Methods Focal osteogenesis was induced in the right hindlimb of mice through surgical initiation of a small transcortical defect in the tibia (fracture callus; n = 7/group) or intramuscular injection of BMP-2 (HO lesion; n = 6/group), both in the presence/absence of adjacent calf paralysis. High-resolution micro-CT images were obtained in all experimental groups 21 days postinduction and total volume (ie, perimeter of periosteal callus or HO lesion) and bone volume (calcified tissue within the total volume) were quantified as primary outcome measures. Finally, these outcome measures were compared to determine the effect of muscle paralysis on inhibition of local osteogenesis in both studies.Results After a transcortical defect, BTxA-treated mice showed profound inhibition of osteogenesis in the periosteal fracture callus 21 days postsurgery compared with saline-treated mice (total volume: 0.08 ± 0.06 versus 0.42 ± 0.11 mm 3 , p \ 0.001; bone volume: 0.07 ± 0.05 versus 0.32 ± 0.07 mm 3 , p \ 0.001). Similarly, BMP-2-induced HO formation was inhibited by adjacent muscle paralysis at the same time point (total volume: 1.42 ± 0.31 versus 3.42 ± 2.11 mm 3 , p = 0.034; bone volume: 0.68 ± 0.18 versus 1.36 ± 0.79 mm 3 , p = 0.045). Conclusions Our data indicate that BTxA-induced neuromuscular inhibition mitigated osteogenesis associated with both a transcortical defect and BMP-2-induced HO. Clinical Relevance Focal neuromuscular inhibition represents a promising new approach that may lead to a new clinical intervention to mitigate trauma-induced HO, a healthcare challenge that is severely debilitating for civilian and war-wounded populations, is costly to both the patient and the healthcare system, and currently lacks effective treatments.

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“…Dual approaches to the proximal radius, commonly utilized for bicep tendon repair and reconstruction, result in proximal forearm synostosis. Traumatic injury is also associated with HO formation from isolated limb fractures and fracture dislocations of the joints due to polytrauma 6, 7, 8, 9, 10…”

Section: Injuries and Surgeriesmentioning

confidence: 99%

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

Juarez

Wenke

Rivera

2018

Clinical Translational Sci

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Heterotopic Ossification After Surgery for Fractures and Fracture-Dislocations Involving the Proximal Aspect of the Radius or Ulna

Cited by 117 publications

References 2 publications

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Injury Complexity Factors Predict Heterotopic Ossification Restricting Motion After Elbow Trauma

Botulinum Toxin-induced Muscle Paralysis Inhibits Heterotopic Bone Formation

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

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