Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospect
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RESEARCH ARTICLE
Open Access
Incidence and clinical relevance of heterotopic ossification after internal fixation of acetabular fractures: retrospective cohort and case control study Dominik Baschera1*†, Hooman Rad1†, Dermot Collopy1 and René Zellweger1,2
Abstract Objective: The aim of the study was to evaluate predictors and clinical relevance of heterotopic ossification (HO) in patients treated for acetabular fractures in a tertiary referral centre. Patients and methods: The study is a retrospective cohort study with a nested case–control study. All patients treated with internal fixation of acetabular fractures from January 2004 to October 2013. Ninety patients had postoperative imaging available at 6 and 12 months postoperatively and received no prophylaxis. Plain radiographs were used to grade HO. The Hip disability and Osteoarthritis Outcome Score (HOOS) was used to compare outcomes between patients suffering from HO with patients who did not. Results: Sixteen patients (17.7%) suffered from HO. According to the Brooker classification, 5 had class I, 4 class II, 3 class III and 4 class IV HO. Traumatic brain injury (TBI) was the only significant risk factor for developing HO (odds ratio (OR) 8.6, 95% confidence interval (CI) (1.693–43.753), p = 0.014). The HO rate in patients with an anterior (ilioinguinal) or posterior (Kocher-Langenbeck) surgical approach was 20% and 21% respectively, and the HO rate in patients with a combined approach was much lower at 11%. Neither fracture type nor gender nor age increased the risk of HO significantly. The outcome measured by HOOS was not significantly different between patients with HO and patients in the control group. Patients with HO Brooker class II–IV had slightly lower (effect estimate +4.25, 95% CI (−10.2 to +12.10), p = 0.220) HOOS compared to the majority of the control group. Conclusion: A very low rate of HO was found compared to the HO rates described in other studies with similar patient cohorts who received prophylaxis. Based on our findings and the current literature, we do not recommend giving prophylaxis against HO to patients after internal fixation of acetabular fractures. Keywords: Acetabular fractures, Heterotopic ossification, Prophylaxis, Internal fixation, Trauma
Background Heterotopic ossification (HO) in patients receiving internal fixation of acetabular fractures is a potentially disabling complication that occurs in up to 58% of cases [1,2]. In many centres, indomethacin or low-dose radiotherapy is administered as prophylaxis to prevent the development of HO, although these practices are still * Correspondence: [email protected] † Equal contributors 1 Department of Orthopaedics and Trauma Surgery, Royal Perth Hospital, Perth, WA 6000, Australia Full list of author information is available at the end of the article
controversial. Heterotopic ossification is a process by which the soft tissue becomes ossified. It occurs when primitive mesenchymal cells in the surrounding soft tissue are transformed into osteoblastic cells. Differentiatio
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