Heterotopic Ossification After Femoral Intramedullary Rodding

Steinberg, Gerald G.; Hubbard, Charles W.

doi:10.1097/00005131-199312000-00009

Cited by 38 publications

(22 citation statements)

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“…Interestingly, prolonged mechanical ventilation has been demonstrated as a risk factor for HO in other studies assessing hips without a fracture of the acetabulum, around uninjured joints, or around the hip after femoral nailing [17,23,30]. Pape et al [23] demonstrated an increased frequency of HO around uninjured joints in polytraumatized patients without head trauma compared with patients with head trauma suggesting that other pathways are involved.…”

Section: Discussionmentioning

confidence: 98%

“…Injury Severity Score (ISS) has also been demonstrated as a risk factor for ectopic bone around the hip after femoral nailing as well as around the knee after knee dislocation [17,20]. Need for prolonged mechanical ventilation has been demonstrated as a risk factor for the development of ectopic bone in uninjured joints of polytraumatized patients as well as around the hip after femoral nailing [17,23,30], but to our knowledge, not specifically after operatively treated acetabular fractures.…”

Section: Introductionmentioning

confidence: 99%

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

Firoozabadi

O'Mara

Swenson

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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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

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

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

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“…Up to 64% [3,15] of combat casualties develop radiographically evident HO, which is far greater than that reported in civilian trauma literature [6][7][8][9]17]. Approximately one-third of these will eventually undergo surgical excision for symptomatic lesions.…”

Section: Introductionmentioning

confidence: 93%

Preventing Heterotopic Ossification in Combat Casualties—Which Models Are Best Suited for Clinical Use?

Alfieri

Potter

Davis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background To prevent symptomatic heterotopic ossification (HO) and guide primary prophylaxis in patients with combat wounds, physicians require risk stratification methods that can be used early in the postinjury period. There are no validated models to help guide clinicians in the treatment for this common and potentially disabling condition. Questions/purposes We developed three prognostic models designed to estimate the likelihood of woundspecific HO formation and compared them using receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) to determine (1) which model is most accurate; and (2) which technique is best suited for clinical use. Methods We obtained muscle biopsies from 87 combat wounds during the first débridement in the United States, all of which were evaluated radiographically for development of HO at a minimum of 2 months postinjury. The criterion for determining the presence of HO was the ability to see radiographic evidence of ectopic bone formation within the zone of injury. We then quantified relative gene expression from 190 wound healing, osteogenic, and vascular genes. Using these data, we developed an Artificial Neural Network, Random Forest, and a Least Absolute Shrinkage and Selection Operator (LASSO) Logistic Regression model designed to estimate the likelihood of eventual woundspecific HO formation. HO was defined as any HO visible on the plain film within the zone of injury. We compared the models accuracy using area under the ROC curve (area under the curve [AUC]) as well as DCA to determine which model, if any, was better suited for clinical use. In general, the AUC compares models based solely on accuracy, whereas DCA compares their clinical utility after weighing the consequences of under-or overtreatment of a particular disorder. Results Both the Artificial Neural Network and the LASSO logistic regression models were relatively accurate with AUCs of 0.78 (95% confidence interval [CI], 0.72-0.83) and 0.75 (95% CI, 0.71-0.78), respectively. The Random Forest model returned an AUC of only 0.53 (95% CI, 0.48-0.59), marginally better than chance alone. Using DCA, the Artificial Neural Network model demonstrated the highest net benefit over the broadest range of threshold probabilities, indicating that it is perhaps better suited for clinical use than the LASSO logistic regression model. Specifically, if only patients with greater than 25% risk of developing HO received prophylaxis, for every 100 patients, use of the Artificial Network Model would result in six fewer patients who unnecessarily receive prophylaxis compared with using the LASSO regression model while not missing any patients who might benefit from it. Conclusions Our findings suggest that it is possible to risk-stratify combat wounds with regard to eventual HO formation early in the débridement process. Using these data, the Artificial Neural Network model may lead to better patient selection when compared with the LASSO logistic regression approach. Future prospective studie...

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“…Die chirurgische Technik ist jedoch nicht ohne Nachteile: Man ben/)tigt regelm~iBig einen Extensionstisch mit dem Risiko einer L~ision des Nervus pudendus sowie l~ingere Zeit ftir den Aufbau im Operationssaal und muB bei mehrfachverletzten Patienten mit logistischen Problemen der gleichzeitigen oder aufeinander folgenden Operationen fertig werden. Das Verfahren ist bei ipsilateralen Frakturen des Schenkelhalses und -schafts nur begrenzt einsetzbar und tr~igt das Risiko heterotoper Ossifikationen um die Htifte [3,5,10,[17][18][19]. Eine schlechte postoperative Funktion des Htiftgelenkes stellt ein weiteres wichtiges Problem dar.…”

Section: Vorbemerkungenunclassified

Die retrograde Marknagelung von Femurschaftfrakturen

Moed

Watson

1998

Orthop Traumatol

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Zusammenfassung Operationsziel Indikationen Interne Fixation von Oberschenkelfrakturen fiber eine geschlossene retrograde Marknagelung. Zusfitzliche Stabilisierung tiber eine distale und proximale Verriegelung. Femurschaftfrakturen bei mehrfachverletzten Patienten. Ausgew~ihlte Serienverletzungen einer unteren Extremit~t. Femurfrakturen mit Gef~i61~ision. Kontraindikationen Operationstechnik Ergebnisse Infektionen des Kniegelenks in der Anamnese oder stark verschmutzte Wunden. Unf~ihigkeit, das Knie auf 45 ~ zu beugen. Lagerung auf einem strahlendurchlassigen Operationstisch mit auf 45 ~ gebeugtem Kniegelenk. Reposition der Fraktur. L~ngsschnitt fiber dem Ligamentum patellae und Spaltung des Ligaments. Eintrittspunkt in der Interkondyl~irgrube 1 cm vor dem Ansatz des hinteren Kreuzbandes. Aufbohren nicht unbedingt erforderlich (optional). Distale und proximale Verriegelung mit Schrauben, die von lateral nach medial eingebracht werden. Erste Serie von 22 statisch verriegelten Frakturen bei 20 mehrfachverletzten Patienten (17 M~nner, drei Frauen; Alter 19 bis 60 Jahre, Durchschnitt 35 Jahre). Bei der Nachuntersuchung sechs bis 24 Monate sp~iter (durchschnittlich 13 Monate) kn6cherne Heilung bei 86%. Durchschnittliche Heilungszeit 15 Wochen. Keine Infektionen oder wesentlichen Achsenfehler. Zweite Serie von 35 Frakturen bei 34 Patienten (Alter 15 his 88 Jahre, durchschnittlich 34 Jahre, 22 M~inner, zwOlf Frauen). Es wurde mehr Wert auf einen m6glichst grof3en Nageldurchmesser und eine frtihe Dynamisierung gelegt. Die Heilungsrate lie6 sich auf 94% (33/35) steigern und die durchschnittliche Heilungszeit auf 12,6 Wochen senken. Keine Infektionen, keine wesentlichen Achsenfehler.

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Heterotopic Ossification After Femoral Intramedullary Rodding

Cited by 38 publications

References 0 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

Preventing Heterotopic Ossification in Combat Casualties—Which Models Are Best Suited for Clinical Use?

Die retrograde Marknagelung von Femurschaftfrakturen

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