Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation.

Bosse, Michael J.; Poka, Attila; Reinert, Charles M.; Ellwanger, F; Slawson, Robert G.; McDevitt, Ellen

doi:10.2106/00004623-198870080-00016

Cited by 128 publications

(72 citation statements)

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“…The primary outcome was the presence of clinically important HO as seen on radiographs defined as Brooker Classes III and IV by prior studies of HO after open reduction and internal fixation of acetabular fracture [4]. All followup radiographs were independently graded by two fellowship-trained orthopaedic trauma surgeons (JWM, TSA) who were blinded to the treatment each patient received using the Moed modification of the Brooker classification, which uses two additional radiographic views-the iliac and obturator obliques-to measure …”

Section: Methodsmentioning

confidence: 99%

“…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%

“…There is substantial evidence to support the inflammatory etiology of HO; therefore, nonsteroidal antiinflammatory drugs such as indomethacin have been commonly prescribed as prophylaxis [12,14,15,22]. Initial reports found indomethacin to be effective in preventing clinically important HO, which has been defined as Brooker Classes III and IV HO [4], although more recent prospective studies have found increased risk of posterior wall nonunion and no change in rates of clinically important HO [22]. Radiotherapy prevents abnormal formation of bone by inhibiting the differentiation of mesenchymal stem cells to osteogenic pathways [8,19].…”

Section: Introductionmentioning

confidence: 99%

“…Radiotherapy prevents abnormal formation of bone by inhibiting the differentiation of mesenchymal stem cells to osteogenic pathways [8,19]. Although radiotherapy has been shown to be effective in numerous studies, the potential risk of malignant transformation and wound complications must be considered [1,4,9,17]. Increased time of hospitalization and delay to the operating room to arrange for radiation should also be taken into account.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

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

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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...

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Section: Methodsmentioning

confidence: 99%