Heterotopic Ossification in adults following a burn: A phenomenological analysis

Foster, Nichola; Kornhaber, Rachel; McGarry, Sarah; Wood, Fiona; Edgar, Dale W.

doi:10.1016/j.burns.2017.03.001

Cited by 15 publications

(9 citation statements)

References 40 publications

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“…11 HO pain was described as ‘sharp’ and ‘stabbing’, a symptom that was distinguishable from the pain experience of burn injury alone. 2 Early clinical signs of HO have been reported at means of 37–43 days post burn injury 14,28 though diagnosis is reported as early as 12 days post injury. 15 This preceded radiological confirmation by a mean of at least five days to several weeks.…”

Section: Resultsmentioning

confidence: 99%

“…47,51 Further, in a qualitative study, HO and loss of ROM was associated with poorer functional outcomes and negative impact on participation and return to normal social roles. 2 In a neurological trauma population, delayed surgery did not correlate with clinical necessity of resection. 52 Thus, earlier excision of HO has been explored.…”

Section: Treatmentmentioning

confidence: 95%

“…Heterotopic ossification (HO) is a relatively rare complication after burn injury. However, it remains a problematic issue for burn survivors as it causes significant long-term disorders including reduced range of movement (ROM) and function, 1 extreme pain, 2 and nerve entrapment. 3 The etymologic roots of the term HO derive from Greek origins, heteros topos , meaning different place and the Latin ossificatio , meaning bone formation.…”

Section: Introductionmentioning

confidence: 99%

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The development and impact of heterotopic ossification in burns: a review of four decades of research

Kornhaber

Foster

Edgar

et al. 2017

Scars, Burns & Healing

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Introduction:Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury.Methods:The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus.Results:Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols.Discussion:Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected.Conclusion:The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients.

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Section: Resultsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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The development and impact of heterotopic ossification in burns: a review of four decades of research

Kornhaber

Foster

Edgar

et al. 2017

Scars, Burns & Healing

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“…Patient-reported movement restrictions and intractable pain are early signs of burninduced HO. Patients can feel that their joints are locked or fused, with less ROM and sharp stabbing pains (nerve compression) [26]. A study from the Burn Model System National Database found that the presence of HO significantly increases the absolute loss of elbow flexion (adjusted median of 23.5°), which causes more serious elbow contracture [27].…”

Section: Presentation and Diagnosis Of Burn-induced Homentioning

confidence: 99%

“…A study from the Burn Model System National Database found that the presence of HO significantly increases the absolute loss of elbow flexion (adjusted median of 23.5°), which causes more serious elbow contracture [27]. Moreover, burn-induced HO not only causes physical limitations but also psychological burdens, such as worry and distress [26]. In turn, HO can induce recurrent non-healing ulcers in the old burn scar [28].…”

Section: Presentation and Diagnosis Of Burn-induced Homentioning

confidence: 99%

Burn-induced heterotopic ossification from incidence to therapy: key signaling pathways underlying ectopic bone formation

Sun

et al. 2021

Cell Mol Biol Lett

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Burn injury is one of the potential causes of heterotopic ossification (HO), which is a rare but debilitating condition. The incidence ranges from 3.5 to 5.6 depending on body area. Burns that cover a larger percentage of the total body surface area (TBSA), require skin graft surgeries, or necessitate pulmonary intensive care are well-researched risk factors for HO. Since burns initiate such complex pathophysiological processes with a variety of molecular signal changes, it is essential to focus on HO in the specific context of burn injury to define best practices for its treatment. There are numerous key players in the pathways of burn-induced HO, including neutrophils, monocytes, transforming growth factor-β1-expressing macrophages and the adaptive immune system. The increased inflammation associated with burn injuries is also associated with pathway activation. Neurological and calcium-related contributions are also known. Endothelial-to-mesenchymal transition (EMT) and vascularization are known to play key roles in burn-induced HO, with hypoxia-inducible factor-1 (HIF-1) and vascular endothelial growth factor (VEGF) as potential initiators. Currently, non-steroidal anti-inflammatory drugs (NSAIDs) and radiotherapy are effective prophylaxes for HO. Limited joint motion, ankylosis and intolerable pain caused by burn-induced HO can be effectively tackled via surgery. Effective biomarkers for monitoring burn-induced HO occurrence and bio-prophylactic and bio-therapeutic strategies should be actively developed in the future.

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Heterotopic Ossification in Patients with Burns: a Systematic Literature Review

Skorochod

Nesher

Gronovich

2022

Curr Phys Med Rehabil Rep

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Heterotopic Ossification in adults following a burn: A phenomenological analysis

Cited by 15 publications

References 40 publications

The development and impact of heterotopic ossification in burns: a review of four decades of research

The development and impact of heterotopic ossification in burns: a review of four decades of research

Burn-induced heterotopic ossification from incidence to therapy: key signaling pathways underlying ectopic bone formation

Heterotopic Ossification in Patients with Burns: a Systematic Literature Review

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