Citation

d'Heurle A, Archdeacon MT, Hiratzka S, Casstevens C, Finnan R, McCoy B. J. Orthop. Trauma 2015; 30(4): 213-216.

Affiliation

Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of Cincinnati, Cincinnati, OH USA.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/BOT.0000000000000490

PMID

26606599

Abstract

OBJECTIVES: To determine the relationship between injury severity surrogates and other patient factors with the development and severity of heterotopic ossification (HO) following ORIF of acetabular fractures treated with a posterior approach.

DESIGN: Retrospective review SETTING:: Academic level 1 trauma center. PATIENTS/PARTICIPANTS: 241 patients who were treated through a posterior approach with a minimum of 6 month radiographic follow up were identified from an acetabular fracture database. INTERVENTION: None MAIN OUTCOME MEASUREMENTS:: The occurrence and severity (Brooker Grade III / IV) of heterotopic ossification (HO) six months post surgery.

RESULTS: Length of stay (LOS) in the Intensive Care Unit (ICU), non-ICU LOS >10 days and HO prophylaxis with external radiation beam therapy (XRT) were significantly associated with the development of HO in a multivariate model [ICU LOS: 1-2 days OR = 4.33, 95% CI: 1.03-18.25; 3-6 days OR=4.1, 95% CI: 1.27-13.27; >6 days OR=11.7, 95% CI 3.24-42.22_; Non-ICU LOS >10 day (vs 0-6 days): OR = 7.6, 95% CI: 2.6-22.25; XRT HO prophylaxis: OR = 0.29, 95% CI: 0.10-0.85]. Other variables evaluated in multivariate modeling not significantly associated with development and severity of HO included age, gender, mechanism of injury, injury severity score (ISS), presence of neurologic injury, Letournel fracture type, occurrence of hip dislocation, interval from injury to surgery, operative time and estimated blood loss.

CONCLUSIONS: Surrogates of injury severity including days in the ICU and non-ICU hospital LOS >10 days were associated with the development of HO in our cohort of acetabular fracture patients. Prophylaxis with XRT was significantly protective against the development of HO, and the ability to provide prophylaxis is very likely related to the severity of injury. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Language: en