Posttraumatic Heterotopic Ossification of the Hip

Behery, Omar A.; Dai, Amos Z.; McLaurin, Toni M

doi:10.1097/bot.0000000000001197

Cited by 12 publications

(10 citation statements)

References 4 publications

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“…A complication often described with HO excision is morbidity related to blood loss, with documented EBL ranging from 900 mL up to over 5 L in cases of vascular injury intraoperatively,3 6 9–11 with some patients requiring blood transfusions postoperatively. In one case described by Gardland et al 3 the femoral vein was lacerated causing over 5 litres of blood loss.…”

Section: Discussionmentioning

confidence: 99%

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification

Zieliński¹,

Chiang

Satpathy

2019

BMJ Case Rep

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The surgical excision of heterotopic ossification can provide improved function for patients; however, complications can include damage to nearby vessels and nerves, blood loss and recurrence. In the preoperative planning for excision, our case report describes the combination of CT angiography, preoperative embolisation of involved vascular structures and the use of intraoperative vascular surgery for dissection around key structures to aid in the reduction of morbidity in these patients.

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Section: Discussionmentioning

confidence: 99%

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification

Zieliński¹,

Chiang

Satpathy

2019

BMJ Case Rep

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“…is found after closed reduction for the dislocated hip joint, surgical intervention (excision or fixation) should be considered. Most prior published work limits the generalizability of those findings including either case or single institutional reports [13], and various surgical methods. We still need large multicenter randomized control trials to better understand the optimal treatment for Type I Pipkin femoral head fractures.…”

Section: Limitationsmentioning

confidence: 99%

“…However, surgery may be indicated if a comminuted fracture fragment prevented successful reduction of the hip joint. Complications, including heterotopic ossification (HO), avascular necrosis (AVN), and post-traumatic arthritis can limit patient's hip function and postoperative outcomes [6,[13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures?: A Systematic Review and Meta-Analysis

Tsai

Tai

et al. 2022

Life

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Background: Femoral head fractures are rare injuries with or without traumatic dislocations. The management of these fractures is crucial to prevent the development of severe complications and to achieve optimal functional outcomes. Wide treatment options for Pipkin 1 femoral head fractures range from fragment excision, fixation following open reduction with internal fixation, or conservative treatment such as close reduction alone after fracture dislocation. However, the best decision making remains controversial not only due to lack of large trials, but also inconsistent results reported. Therefore, we aim to compare the operative with nonoperative outcomes of Pipkin type 1 patients. Patients and Methods: We systemically searched MEDLINE, EMBASE, Cochrane library, In-Process & Other Non-Indexed Citations to identify studies assessing outcomes of Pipkin type 1 patients after conservative treatment, and open reduction with excision or fixation. Data on comparison of clinical outcomes of each management were extracted including arthritis, heterotopic ossification (HO), avascular necrosis (AVN), and functional scores (Thompson Epstein, Merle’ d Augine and Postel Score). We performed a meta-analysis with the available data. Results: Eight studies (7 case series and 1 RCT) were included in this study. In a pooled analysis, the overall rate of arthritis was 37% (95% CI, 2–79%), HO was 20% (95% CI, 2–45%), and AVN was 3% (95% CI, 0–16%). In comparison of management types, the excision group reached the best functional outcomes including Thompson Epstein Score (poor to worse, 9%; 95% CI, 0–27%) and Merle d’ Aubigne and Postel Score (poor to worse, 18%; 95% CI, 3–38%); ORIF group had the highest AVN rate (11%; 95% CI, 0–92%); conservative treatment had the highest arthritis rate (67%; 95% CI: 0–100%) and lowest HO rate (2%; 95% CI, 0–28%). Discussion: This meta-analysis demonstrates that different procedures lead to various clinical outcomes: fragment excision may achieve better function, conservative treatment may result in a higher arthritis rate, while ORIFs may have a higher AVN rate. These findings may assist surgeons in tailoring their decision-making to specific patient profiles. Future RCTs with multicenter efforts are needed to validate associations found in this study. Level of Evidence: II, systematic review and meta-analysis.

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“…Current evidences showed complications such as HO,AVN and PTOA can limit patient's hip function and postoperative outcomes [11][12][13]. Internal xation or excision of the head fragments can be performed depending on location and size to establish congruency and to prevent arthritis.…”

Section: Introductionmentioning

confidence: 99%

Modified S-P approach and Ganz surgical dislocation for the treatment of Pipkin I-type fractures: a long-term retrospective study

Zhang,

Deng,

Wang

et al. 2023

Preprint

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Background Posterior hip dislocation is the commonest type of hip dislocation. As it frequently combined fractures and may cause complications. Urgent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of the present study is to compare the clinical efficacy of the modified Smith-Peterson (mS-P) and Ganz surgical dislocation (GSD) in treating Pipkin I fractures. Methods A retrospective analysis of 23 patients diagnosed with Pipkin I femoral head fracture was conducted in Pidu District People's Hospital from June 2010 to May 2020. Regarding the treatment classification, 11 cases were treated with mS-P approach and 12 cases were treated with GSD approach. 1 case in each group lost the follow-up period in this study. The follow-up time of the rest 21 patients was 12–55 months, with an average of 37.7 months. Functional evaluation was done using the Thompson-Epstein Score, Modifed Harris Hip Score(MHHS), and Vail Hip Score (VHS) at final follow-up. The incision length, intraoperative time, intraoperative blood loss, intraoperative blood transfusion, length of stay in hospital, fracture healing time, and postoperative complications were also examined and compared between the two groups. Results According to the Thompson-Epstein function evaluation system, 6 patients (60%) had excellent results, 3 patients (30%) were rated as good, 1 patients (10%) as fair, and the excellent and good rate was 90% in mS-P group. And 3 patients (27.2%) had excellent results, 5 patients (45.5%) were rated as good, 2 patients (18.2%) as fair, 1 patient (9%) as poor and the rate of Excellent and Good results was 72.7% in GSD group. According to Harris hip score, 4 patients (40%) were rated as excellent, 2 patients (20%) as good; 4 patients (50%) as fair in mS-P group. Among cases of GSD group, 1 patient (9%) was rated as Excellent, 2 patients (18.2%) as good, 7 patients (63.6%) as fair and 1 patient (9%) as poor. According to VSH score, the average score of mS-P group was 82.3, and 74.4 in GSD group. Conclusions Both the mS-P and GSD approach can achieve a satisfactory result in surgical treatment of Pipkin I fractures. Open reduction and internal fixation(ORIF) of Pipkin I fractures using mS-P approach is more visual and less invasive than GSD approach, as well as less amount of bleeding. However, mS-P approach cannot provide satisfactory results with low occurrence of postoperative complications.

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Posttraumatic Heterotopic Ossification of the Hip

Abstract: Posttraumatic hip HO can cause significantly limited hip ROM and pain with resulting disability. Surgical excision of posttraumatic hip HO in a preserved hip joint can be successful in restoring hip ROM and function. Appropriate postoperative HO prophylaxis can prevent recurrence.

Cited by 12 publications

References 4 publications

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification

The role of preoperative vascular imaging and embolisation for the surgical resection of bilateral hip heterotopic ossification

Does Surgical Repair Benefit Pipkin Type I Femoral Head Fractures?: A Systematic Review and Meta-Analysis

Modified S-P approach and Ganz surgical dislocation for the treatment of Pipkin I-type fractures: a long-term retrospective study

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