Heterotopic Ossification in Acetabular Fractures: Systematic Review and Meta-Analysis of Prophylaxis

Bueno, Thiago Sanchez Pires; Godoy, Gabriel Paris De; Furukava, Rebeca B; Gaggioli, Nicole Takakura; Tamaoki, Marcel Jun Sugawara; Matsunaga, Fábio Teruo; Belloti, João Carlos

doi:10.1590/1413-785220212906244689

Cited by 3 publications

(3 citation statements)

References 37 publications

(117 reference statements)

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“…However, there are increasing numbers of studies in the literature stating that the modified Stoppa approach is a good alternative to the ilioinguinal approach (10)(11)(12). One of the controversial issues is heterotopic ossification prophylaxis (13). We routinely administered indomethacin prophylaxis in our cases.…”

Section: Discussionmentioning

confidence: 99%

Cerrahi Olarak Tedavi Edilen Asetabulum Kırıklarının Klinik ve Radyolojik Değerlendirmesi

Muratoğlu

Yılmaz

Atlıhan

et al. 2022

Düzce Tıp Fakültesi Dergisi

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Aim: Acetabular fractures were evaluated by Judet and Letournel in two main groups as elementary and associated fractures. There are publications in the literature that the results are worse as the complexity of the fracture increases. The aim of this study was to evaluate whether clinical outcomes are worse in associated fractured patients. Material and Methods:The study included 48 acetabular fractures admitted to the emergency room and treated surgically between December 2011 and October 2020. Patient's trauma, additional injuries, surgical method, early or late complications, and range of motion at the last follow-up were documented. Clinical and radiological results of the patients were evaluated by modified Merle d'Aubigné, functional capacities by Harris hip scoring systems. Results: There were 25 elementary fractures and 23 associated fractures in patients. When the complication rates were examined, the rate of those without complications was 52.0% (n=13) among elementary fractures, while the rate was 34.8% (n=8) in associated fractures. When the fracture types were evaluated according to the Harris hip score, elementary fractures have better score than associated fractures, but no statistically significant difference was observed between them (p=0.056). When evaluated according to Merle d'Aubigne score, it was observed that elementary fractures had significantly better scores (p=0.004). Conclusion:As the complexity of the fracture increases, it can be predicted that the clinical outcomes of the patient will be worse. It is also concluded that the elementary fracture type had better clinical outcomes than the associated fracture type in our own surgically treated acetabular fractures.

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Section: Discussionmentioning

confidence: 99%

Cerrahi Olarak Tedavi Edilen Asetabulum Kırıklarının Klinik ve Radyolojik Değerlendirmesi

Muratoğlu

Yılmaz

Atlıhan

et al. 2022

Düzce Tıp Fakültesi Dergisi

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“…Several prophylactic treatments for HO have been proposed, such as non-steroidal anti-inflammatory drugs (NSAIDs), Noggin (an extracellular peptide that binds and antagonizes bone morphogenetic proteins), pulsed electromagnetic fields, and free radical scavengers (3)(4)(5)(6)(7)(8)(9)(10)(11).…”

Section: Evidence On Prophylactic Radiotherapy (Rt) In Hip Heterotopi...mentioning

confidence: 99%

“…However, optimal dose, technique and timing remain unclear, as does the usefulness of combining RT with drugs.Heterotopic ossification (HO) is defined as the formation of new bone in soft tissue outside the skeletal system (1). HO can be differentiated into three main groups: traumatic HO (mainly following fractures), non-traumatic HO (usually occurring after burns), and neurological HO (2).Several prophylactic treatments for HO have been proposed, such as non-steroidal anti-inflammatory drugs (NSAIDs), Noggin (an extracellular peptide that binds and antagonizes bone morphogenetic proteins), pulsed electromagnetic fields, and free radical scavengers (3)(4)(5)(6)(7)(8)(9)(10)(11).HO is a particularly frequent complication after total hip arthroplasty, with reported rates ranging from 15% to 90%. In patients with a significant amount of ossification, hip mobility can be impaired (12).…”

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confidence: 99%

Prophylactic Radiotherapy of Hip Heterotopic Ossification: A Narrative Mini Review

Galietta

Gaiani

Giannini

et al. 2022

In Vivo

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Evidence on prophylactic radiotherapy (RT) in hip heterotopic ossification (HO) is sparse and conflicting.The aim of this literature review was to collect and summarize the available data on RT efficacy in preventing hip HO. The results of this review show that RT is effective in the prevention of hip HO, albeit with large variability across series. Effective prophylactic RT requires optimal treatment fields and time intervals with surgery. On the contrary, there is no clear evidence on the optimal timing (post-operative versus pre-operative RT). Comparisons between prophylactic RT and use of non-steroidal antiinflammatory drugs showed conflicting results, although most were in favor of RT. In conclusion, RT is an established prophylactic treatment for hip HO. However, optimal dose, technique and timing remain unclear, as does the usefulness of combining RT with drugs.Heterotopic ossification (HO) is defined as the formation of new bone in soft tissue outside the skeletal system (1). HO can be differentiated into three main groups: traumatic HO (mainly following fractures), non-traumatic HO (usually occurring after burns), and neurological HO (2).Several prophylactic treatments for HO have been proposed, such as non-steroidal anti-inflammatory drugs (NSAIDs), Noggin (an extracellular peptide that binds and antagonizes bone morphogenetic proteins), pulsed electromagnetic fields, and free radical scavengers (3)(4)(5)(6)(7)(8)(9)(10)(11).HO is a particularly frequent complication after total hip arthroplasty, with reported rates ranging from 15% to 90%. In patients with a significant amount of ossification, hip mobility can be impaired (12). Main risk factors for HO after total hip arthroplasty are male gender, hip ankylosis, and previous history of HO (13,14). The only effective treatment of symptomatic, established HO is surgical resection (15).From the early 1980s ( 16), radiotherapy (RT) has been extensively studied and used in this setting. Most evidence on RT efficacy in preventing hip HO comes from nonrandomized studies (17-45), although some randomized trials (46-61) and systematic-reviews and meta-analyses (62-68) have been performed.However, evidence on prophylactic RT is sparse and conflicting, no international guidelines are available, and several questions remain unanswered. Therefore, the aim of this literature review was to collect and summarize the main available evidence on RT efficacy in preventing hip HO.

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A retrospective analysis of different treatments of posterior acetabular wall fracture

et al. 2023

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Introduction/Objective. Analysis of clinical outcomes of non-surgical conservative and operative management of patients with posterior acetabular wall fractures. Methods: We investigated 88 fractures of the acetabular joint, 31 of which were treated surgically and 57 non-surgically. Only screws or reconstruction plates and screws were used for surgical treatment and traction in patients who underwent nonsurgical treatment. The study period lasted at least three years. The measures used to assess the outcome of operative, surgical and non-operative, conservative approach were Merle D'Aubigne modified score, Harris hip score, and Matta radiometric criteria. Results. Matta evaluation criteria showed excellent score for 40.40% in conservatively treated patients; 19.4% in patients who underwent surgery; good score for 49.10% in conservatively treated patients; 48.40% in patients who underwent surgery. Comparation between two group patients differently treated, by Merle D?Aubigne tool, showed excellent results for 56.10% conservatively-treated patients and 25.8% in those patients who underwent surgery and good results in 29.8% conservatively-treated patients and 38.7% in patients who underwent surgery. Harris Hip Score (excellent results were showed in 54.4% for non-operative-treated patients) showed also statistical significance, p < 0.005. Conclusion. Proper diagnostics and proper definitive diagnosis can avoid surgical treatment if the fracture cannot be treated surgically, making the postoperative period more comfortable for the patient.

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Heterotopic Ossification in Acetabular Fractures: Systematic Review and Meta-Analysis of Prophylaxis

Cited by 3 publications

References 37 publications

Cerrahi Olarak Tedavi Edilen Asetabulum Kırıklarının Klinik ve Radyolojik Değerlendirmesi

Cerrahi Olarak Tedavi Edilen Asetabulum Kırıklarının Klinik ve Radyolojik Değerlendirmesi

Prophylactic Radiotherapy of Hip Heterotopic Ossification: A Narrative Mini Review

A retrospective analysis of different treatments of posterior acetabular wall fracture

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