Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries

Genêt, F.; Jourdan, C.; Schnitzler, A.; Lautridou, C.; Guillemot, Didier; Judet, T.; Poiraudeau, Serge; Denormandie, P.

doi:10.1371/journal.pone.0016632

Cited by 90 publications

(99 citation statements)

References 35 publications

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“…Therefore, we choose the method of revision surgical resection in our case study. (2,3,13,14) Conclusion HO presents multiple diagnostic and therapeutic challenges. Although clinically significant HO occurs infrequently.…”

Section: Discussionmentioning

confidence: 99%

Acquired Neurogenic Heterotopic Ossification Following Treatment for ADEM: A Case Report and Literature Review

Adipudi¹

2018

jmscr

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Section: Discussionmentioning

confidence: 99%

Acquired Neurogenic Heterotopic Ossification Following Treatment for ADEM: A Case Report and Literature Review

Adipudi¹

2018

jmscr

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“…After wound closure, postoperative AP and lateral radiographs of the residual limb were obtained as baseline images. The rats were maintained for 24 weeks, and serial orthogonal radiographs of the residual limb were obtained at 10 days and at 4,8,12,16,20, and 24 weeks. Euthanasia was planned for all animals at 24 weeks.…”

Section: Methodsmentioning

confidence: 99%

“…Abnormal growth results from a disturbance in regulation of normal skeletogenesis and frequently is encountered in other orthopaedic settings, including THA and elbow fracture [1, 3, 11, 20-22, 24, 25] and traumatic brain injury and spinal cord injury [4,8]. Despite being documented as far back as the Civil War, few comprehensive reports on HO frequency in combat-related injuries exist [7,18,19].…”

Section: Introductionmentioning

confidence: 99%

Does Blast Medium Affect Heterotopic Ossification in a Blast-amputation Model?

Yoo

Blevins

Gasbarro

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) develops after nearly 2 .3 of traumatic blast amputations in the contemporary battlefield. This phenomenon has potentially devastating consequences for servicemen and women and its pathophysiology warrants further investigation using a previously developed animal blast model. Questions/purposesWe asked, what is the (1) severity (quantity) and (2) type (location) of HO bone formation after a hindlimb blast amputation with two distinct blast media. We hypothesized that a more ''war-relevant'' blast medium could be a more accurate model and potentially intensify the development of HO. Methods Using a Sprague-Dawley rat model, the pathophysiology of ectopic bone formation in a traumatic hindlimb blast amputation was evaluated. Twenty-four animals underwent blast amputations and closure based on a previously established experimental model. Half the amputations were subjected to blasted sand and the other 1/2 to blasted water. Serial orthogonal radiography was performed on each animal until euthanasia at 24 weeks to track the development of HO. Heterotopic bone severity and type were assessed by three independent graders at each time using a novel grading scale to assess quantity and quality of HO. Results All animals had radiographic evidence of HO develop. No differences were observed in ectopic bone development between sand and water blasting regarding severity or type at any time. Animals that received water and sand blasting had moderate HO develop at 24 weeks (median, 2.0 and 2.5 weeks, respectively; range, 1-3 weeks; difference of medians, 0.5; p = 0.67). At the time of euthanasia, 10 animals that were water blasted had Type 3 HO compared with 11 in the sand-blasted group (p = 1.00).The institution of one or more of the authors (DEJ, VDP) has received, during the study period, funding from the United States Department of Defense Congressionally Directed Medical Research Program (Washington, DC, USA). One of the authors certifies that he (VDP), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,000-USD 1,000,000, from the United States Department of Defense Congressionally Directed Medical Research Program (Washington, DC, USA), an amount of USD 100,000-USD 1,000,000 from DePuy Orthopaedics (Warsaw, IN, USA), and USD 100,000-USD 1,000,000 from the Agency for Healthcare Research and Quality (Rockville, MD, USA). Conclusions Our study showed a clear development of HO after hindlimb blast amputation in a Sprague-Dawley rat model; however, no difference was observed in HO development based on the type of blast media. This suggests it is the blast mechanism that induces ectopic bone development, regardless of the blasted medium. The grading scale we developed for our animal-model study provided a reliable means of assessing HO severity and type. Clinical Relevance We anticipate that future investigations will elucidate similarities between service members' wartime extremity injuries and the animal...

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“…It is known to occur after blunt trauma elbow and acetabular fractures, burns, traumatic brain injury, and spinal cord injury. Recently, interest in HO has increased as a result of its high prevalence in combat-related extremity injuries and amputations [9,10,14,15,17]. Studies have reported the prevalence of HO to be as high as 65% in combat-related amputations, and HO can result in pain, wound breakdown, difficulty with prosthesis wear, entrapment of neurovascular structures, and limited ROM [2,4,6,16,18,20,22,23,26,29,31,32,35].…”

Section: Introductionmentioning

confidence: 99%

What Risk Factors Predict Recurrence of Heterotopic Ossification After Excision in Combat-related Amputations?

Pavey

Polfer

Nappo

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) is common after combat-related amputations and surgical excision remains the only definitive treatment for persistently symptomatic HO. There is no consensus in the literature regarding the timing of surgery, and recurrence frequency, reexcision, and complications have not been reported in large numbers of patients. Questions/purposes (1) What are the rates of symptomatic recurrence resulting in reexcision and other complications resulting in reoperation in patients with HO? (2) Is either radiographic or symptomatic recurrence dependent on timing and type of initial surgery, the experience of the surgeon in performing the procedure, the severity of preexcision HO, the presence of concomitant neurologic injury, or the use of postoperative HO prophylaxis? Methods Between March 2005 and March 2013 our institution treated 994 patients with 1377 combat-related major extremity amputations; of those, 172 amputations underwent subsequent excision of symptomatic HO. The mechanism of injury resulting in nearly all amputations (n = 168) was blast-related trauma. We reviewed medical records and radiographs to collect initial grade of HO, radiographic recurrence, complete compared with partial excision, concomitant neurologic injury, timing to initial surgery, surgeon experience, and use of postexcision prophylaxis with our primary study outcome being a return to the operating room (OR) for repeat excision of symptomatic HO. All 172 combat-related amputations were considered for this study irrespective of followup, which was noted to be robust, with 157 (91%) amputations having 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. All of the authors are employees of the US Government and this work was prepared as part of their official duties. As such, there is no copyright to transfer. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of Defense, nor the US Government. Nothing in the presentation implies any Federal/Department of Defense/Department of the Navy endorsement. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Walter Reed National Military Medical Center, Bethesda, MD, USA. Conclusions HO is common after combat-related amputations, and patients undergoing surgical excisio...

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Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries

Cited by 90 publications

References 35 publications

Acquired Neurogenic Heterotopic Ossification Following Treatment for ADEM: A Case Report and Literature Review

Acquired Neurogenic Heterotopic Ossification Following Treatment for ADEM: A Case Report and Literature Review

Does Blast Medium Affect Heterotopic Ossification in a Blast-amputation Model?

What Risk Factors Predict Recurrence of Heterotopic Ossification After Excision in Combat-related Amputations?

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