Primary Versus Secondary Radiotherapy for Heterotopic Ossification Prevention About the Elbow

Abstract

Objectives: To examine the efficacy and safety of radiotherapy for the prevention of heterotopic ossification (HO) about the elbow.Design: Retrospective chart review.Setting: Level 1 trauma center.Patients/Participants: Two hundred and twenty-nine patients who received prophylactic radiotherapy (XRT) over a 15-year period were identified. Patients were included if they received XRT to the elbow joint and had at least 12 weeks of follow-up after XRT. Fiftyfour patients were ultimately included.Intervention: All patients were treated with a single dose of 7 Gy.Ninety-eight percentage of patients received XRT within 24 hours after surgery, and all patients received XRT within 72 hours after surgery. Main Outcomes Measurements:The primary study measures evaluated were the presence or absence of clinically symptomatic HO and the presence of radiographic HO after XRT to the elbow joint.Results: Eighteen patients were treated with XRT after a traumatic injury requiring surgery (primary prophylaxis), and 36 were treated with XRT after excision surgery to remove HO which had already formed (secondary prophylaxis). In the primary cohort, 16.7% developed symptomatic HO after XRT and 11.1% required surgery to resect the heterotopic bone. In the secondary cohort, 11.1% developed symptomatic HO after surgery and XRT and 5.5% required resection surgery. No secondary malignancies were identified.Conclusions: Our findings suggest that XRT for elbow HO may be safe and effective for both primary and secondary HO. XRT for HO was not shown to be associated with radiation-induced sarcoma in this series, at least in the short term. Further study in a large patient population with extended follow-up is required to better characterize populations at high risk for development of HO and secondary malignancy.

Musculoskeletal Issues in Pediatric Burn Patients

“…36 37 38 Nonsteroidal anti-inflammatory drugs and radiation therapy have been used as adjuncts in the management of HO, particularly after surgery in other clinical scenarios. 32 33 39 40 There are sparse data about their use in burn-injury-related HO. 41…”

“…[36][37][38] Nonsteroidal anti-inflammatory drugs and radiation therapy have been used as adjuncts in the management of HO, particularly after surgery in other clinical scenarios. 32,33,39,40 There are sparse data about their use in burn-injury-related HO. 41 A severe burn injury results in a child losing both bone and muscle mass for a variety of reasons, including the catabolic stress response to injury, nutritional challenges, as well as immobilization for their burn management.…”