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Longer stay in ICU associated with development of heterotopic ossification in acetabular fracture patients
Multivariate analysis showed prophylaxis with external radiation beam therapy was significant protective against heterotopic ossification.
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Any length of stay in an ICU and a stay longer than 10 days in a nonICU following open reduction internal fixation of acetabular fractures was associated with development of heterotopic ossification, while prophylaxis external radiation beam therapy was significantly protective against heterotopic ossification, according to study results.
“It is difficult to predict which patients are at risk for developing heterotopic ossification at the time of injury, but it seems that patients who sustain a high energy trauma requiring length of stays in an ICU setting are at a higher risk than those patients with less severe trauma,” Albert d’Heurle, MD, resident in the Department of Orthopedics at the University of Cincinnati, told Orthopedics Today.
Development of ossification
Utilizing an acetabular fracture database, d’Heurle and colleagues identified 241 patients treated through a posterior approach with a minimum 6-month radiographic follow-up. Main outcome measures included occurrence and severity of heterotopic ossification 6 months postoperatively.
Results showed a significant association between the development of heterotopic ossification and any amount of time spent in the ICU, with ICU length of stay longer than 6 days as the most influential risk factor. Researchers also found development of heterotopic ossification was predicted by a non-ICU length of stay longer than 10 days.
“We were surprised that the injury severity score [was] not a predictor of developing heterotopic ossification, but these other surrogates of injury were,” d’Heurle said.
According to multivariate analysis, heterotopic ossification prophylaxis with external radiation beam therapy was significantly protective. However, researchers noted heterotopic ossification prophylaxis was not equally distributed across all ICU length of stay groups.
“One thing that could be done differently is that for the patients who are in the ICU for an extended period of time, we could be more diligent about ensuring those patients get heterotopic ossification prophylaxis, whether it is with radiation therapy or anti-inflammatory medication,” d’Heurle said.
According to results, 12 patients developed grade III/IV heterotopic ossification. While none of the variables in the multivariate analysis significantly predicted the development of severe heterotopic ossification, researchers found significance in an ICU length of stay longer than 6 days.
Prevention of ossification
According to d’Heurle, future research should focus on understanding and preventing heterotopic ossification in patients.
“Heterotopic ossification affects all sorts of joints, not just the hip; it affects the elbow, [and] you can get it in the shoulder,” he said. “We do not know which patients get it and why they get it, so we could have a better way of preventing it.” – by Casey Tingle
- Reference:
- D’Heurle A, et al. J Orthop Trauma. 2016;doi:10.1097/BOT.0000000000000490.
- For more information:
- Albert d’Heurle, MD, can be reached at the University of Cincinnati, P.O. Box 670212, Cincinnati, OH 45267; email: albert.dheurle@uc.edu.
Disclosure: d’Heurle reports no relevant financial disclosures.