Heterotopic Ossification Following Operative Treatment of Acetabular Fracture An Analysis of Risk Factors

Ghalambor, Navid; Matta, Joel M.; Bernstein, Leslie

doi:10.1097/00003086-199408000-00013

Cited by 108 publications

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“…Excessive HO around the hip can cause severe limitations in ROM leading to decreased function. Although many studies have sought to evaluate risk factors [5,7,14,33], there also are areas of disagreement among these studies [5,7,9,14], which call for further evaluation. Accordingly, this study was designed to determine the specific risk factors that place patients at high risk for developing severe HO.…”

Section: Discussionmentioning

confidence: 99%

“…Of the three classic exposures to the hip, the Kocher-Langenbeck approach is associated with intermediate risk [12]. Ghalambor et al [7] retrospectively evaluated a population of 236 patients with 237 acetabular fractures to determine risk factors for the development of severe HO. These patients were treated surgically through one of the three classic approaches described by Letournel [16].…”

Section: Discussionmentioning

confidence: 99%

“…No inter-or intraobserver reliability was performed. Patients were separated into two groups termed ''not severe'' (Brooker Class 0, I, or II) and ''severe'' (Brooker Class III or IV) [3,7]. For patients with severe HO, the presence of symptoms and/or the need for surgical excision were noted.…”

Section: Methodsmentioning

confidence: 99%

“…Complex exposures, double exposures, and concurrent trochanteric osteotomy are associated with increased risk [1,2,10,21,27,29]. In addition to surgical approach, other factors have been previously identified as potential risk factors for the development of ectopic bone, including male sex, concurrent craniocerebral trauma or thoracoabdominal trauma, Ttype acetabular fracture-associated findings such as sciatic nerve injury, femoral head injury, intraarticular debris, and delay to surgery [5,7,19,33]. Ipsilateral femur fracture may also be associated with increased risk [4].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is a common complication of the operative treatment of acetabular fractures. Although the surgical approach has been shown to correlate with the development of ectopic bone, specific risk factors have not been elucidated. Questions/purposes The purposes of this study were to determine specific risk factors associated with the development of severe HO and the frequency with which patients develop severe HO after acetabular fracture fixation through an isolated Kocher-Langenbeck approach. Methods Using an institutional orthopaedic trauma database at a regional Level I trauma center, patients undergoing open treatment of acetabular fractures during the study period (January 2000 to January 2010) were identified. A review of medical records and imaging studies was performed on 508 patients who were treated by the senior author (MR) through an isolated Kocher-Langenbeck approach. During the study period, the senior author used indomethacin for HO prophylaxis in patients who had ipsilateral femur fracture treated with antegrade reamed medullary nailing or severe local soft tissue injury; 49 (10%) of the patients he treated with the Kocher-Langenbeck approach received prophylaxis, and they were excluded from this study, leaving a total of 459 patients who met inclusion criteria. Of those, 147 (29%) were lost to followup or did not have radiographs both before and at a minimum of 6 weeks (median, 1 week; range, 0-3 weeks), leaving 312 (61% of the patients treated with the Kocher-Langenbeck approach during this time) available for this analysis. Demographic data as well as information related to cause of injury, associated periacetabular findings, other system injuries, and treatment were gathered. Final followup radiographs were assessed for the presence of ectopic bone by two of the authors (TJO, AS) using the modified Brooker classification. Logistic regression was performed to identify possible predictors of development of severe ectopic bone. Results The only predictor we identified for the development of severe HO was the need for prolonged mechanical ventilation (odds ratio, 7

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The risk of HO, depending on surgical approach and patient/injury characteristics, has been reported to be as high as 40% [22]. Heterotopic bone formation is most commonly seen after extended iliofemoral or Kocher-Langenbeck approaches for acetabular reduction and fixation [1,4,11,21]. Other reported risk factors for HO include craniocerebral trauma, fractures associated with posterior hip dislocation, operative delay, ventilation requirement[72 hours, and race [1,4,10,20,24,26].…”

Section: Introductionmentioning

confidence: 99%

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Davis¹,

Roper²,

Munz³

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Controversy regarding heterotopic ossification (HO) prophylaxis exists after Kocher-Langenbeck for treatment of acetabular fracture. Prophylaxis options include antiinflammatory oral medications, single-dose radiation therapy, and débridement of gluteus minimus muscle. Prior literature has suggested single-dose radiation therapy as the best prophylaxis to prevent HO fo'rmation. However, recent reports have emerged of radiation-induced sarcoma after radiotherapy for HO prophylaxis, which has led many surgeons to reconsider the risks and benefits of single-dose radiation therapy. We set out to determine if radiotherapy, in addition to standard débridement of gluteus minimus muscle, affected postoperative HO formation after a Kocher-Langenbeck approach for acetabular fracture. Questions/purposes (1) After the Kocher-Langenbeck approach and gluteus minimus débridement, is single-dose radiotherapy associated with a decreased risk of HO? (2) Does addition of single-dose radiotherapy prolong length of stay after a Kocher-Langenbeck approach and gluteus minimus débridement as compared with patients without radiotherapy? Methods After institutional review board approval, all adult patients treated for acetabular fracture by a single surgeon with a Kocher-Langenbeck approach between August 2011 and October 2014 were identified (n = 60). Débridement of gluteus minimus muscle caudal to the superior gluteal bundle was standard in all patients. Radiotherapy was given with a single dose of 700 cGy within 72 hours of surgery from August 2011 until April 2013. Patients treated subsequently did not receive radiotherapy. Patients treated with indomethacin (n = 1) and with fewer than 10 weeks followup were excluded (n = 12) because several studies suggest that most HO that develops is visible by that point in time. Our study group totaled 46 patients with 24 in the radiotherapy and débridement group and 22 in the débridement group. Charts were reviewed to determine length of stay. Attending orthopaedic trauma surgeons who were blinded to the patient's treatment group graded all followup radiographs according to the Brooker system, and Classes III and IV HO were considered clinically important Fisher's exact test was used to analyze clinically significant differences HO between the two groups. Length of stay was compared using a t-test. Results Single-dose radiotherapy is associated with a decreased risk of clinically important (Brooker III-IV) HO Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any trea...

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Surgical Hip Dislocation in Traumatology

Aprato

Giachino

et al. 2022

Modern Hip Preservation

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Heterotopic Ossification Following Operative Treatment of Acetabular Fracture An Analysis of Risk Factors

Cited by 108 publications

References 0 publications

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

Does Postoperative Radiation Decrease Heterotopic Ossification After the Kocher-Langenbeck Approach for Acetabular Fracture?

Surgical Hip Dislocation in Traumatology

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