Gluteus minimus necrotic muscle debridement diminishes heterotopic ossification after acetabular fracture fixation

Rath, Ehud; Russell, George V.; Washington, W.; Routt, Milton L

doi:10.1016/s0020-1383(01)00194-2

Cited by 69 publications

(63 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of 508 patients were treated by one surgeon (MR) through an isolated KocherLangenbeck approach during this time. Radiation and indomethacin prophylaxis measures were not used routinely based on the results of Rath et al [26], which displayed the value of necrotic gluteus minimus muscle débridement caudal to the superior gluteal neurovascular bundle in preventing HO. However, 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.…”

Section: Methodsmentioning

confidence: 99%

“…The gluteus medius was retracted cephalad and the piriformis and obturator internus were tenotomized and tagged for later repair. Superior and inferior gemelli were débrided as was the caudal aspect of the gluteus minimus, which was routinely noted to be contused and obstructing the area of planned implant application [26]. The sciatic nerve was gently retracted while the knee was held in 90°of flexion.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

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

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Heterotopic ossification (HO) is a common complication that can cause poor postoperative results and functional impairment in an otherwise well-performed acetabular fracture surgery [1,4,20]. The risk of HO, depending on surgical approach and patient/injury characteristics, has been reported to be as high as 40% [22].…”

Section: Introductionmentioning

confidence: 99%

“…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]. The most commonly used prophylactic modalities are indomethacin, single-dose radiotherapy, and gluteus minimus débridement.…”

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

View full text Add to dashboard Cite

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...

show abstract

“…Posterior approaches for acetabular surgery, such as the Kocher‐Langenbeck approach, increase the risk of HO formation in the gluteus minimus muscle. This has been demonstrated by a decreased incidence of HO when necrotic gluteus minimus tissue is debrided after acetabular fracture fixation 4, 5. The upper extremity is also affected, especially following surgical approaches about the elbow.…”

Section: Injuries and Surgeriesmentioning

confidence: 99%

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

Juarez

Wenke

Rivera

2018

Clinical Translational Sci

View full text Add to dashboard Cite

Gluteus minimus necrotic muscle debridement diminishes heterotopic ossification after acetabular fracture fixation

Cited by 69 publications

References 30 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?

Treatments and Preventative Measures for Trauma‐Induced Heterotopic Ossification: A Review

Contact Info

Product

Resources

About