Zusammenfassung
Schwere Schädel-Hirn-Traumata, Rückenmarksverletzungen oder isolierte Gelenkverletzungen können mit heterotopen Ossifikationen einhergehen. Im Zusammenhang mit großflächigen Brandverletzungen stellen periartikuläre Knochenneubildungen eine seltene, schwerwiegende Komplikation dar, deren Pathogenese noch unklar ist. In einer retrospektiven Analyse der in den vergangenen 10 Jahren in unserem Zentrum für Schwerbrandverletzte behandelten 672 Patienten haben wir in 5 Fällen (0,74%) die Problematik der heterotopen Ossifikationen festgestellt.
Abstract
Heterotopic ossifications in peri-articular tissue can appear after severe head injury, spinal trauma or local joint trauma. Following extensive burns, heterotopic ossifications are a rare, but severe complication with an unknown pathogenesis. In a retrospective analysis of 672 patients who were treated in our burn center over the last 10 years we identified 5 cases (0.74%) of heterotopic ossification.
Literatur
Jones KB, Mollano AV, Morcuende JA et al (2004) Bone and brain: a review of neural, hormonal, and musculoskeletal connections. Iowa Orthop J 24:123–132
Pape HC, Marsh S, Morley JR et al (2004) Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br 86(6):783–787
Trentz OA, Handschin AE, Bestmann L et al (2005) Influence of brain injury on early posttraumatic bone metabolism. Crit Care Med 33(2):399–406
McCarthy EF, Sundaram M (2005) Heterotopic ossification: a review. Skeletal Radiol 34(10):609–619
Pape HC, Lehmann U, van GM et al (2001) Heterotopic ossifications in patients after severe blunt trauma with and without head trauma: incidence and patterns of distribution. J Orthop Trauma 15(4):229–237
Jay MS, Saphyakhajon P, Scott R et al (1981) Bone and joint changes following burn injury. Clin Pediatr 20(11):734–736
Kluger G, Kochs A, Holthausen H (2000) Heterotopic ossification in childhood and adolescence. J Child Neurol 15(6):406–413
Pruitt BA Jr (1974) Complications of thermal injury. Clin Plast Surg 1(4):667–691
Evans EB (1966) Orthopaedic measures in the treatment of severe burns. J Bone Joint Surg Am 48(4):643–669
Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr (1973) Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 55(8):1629–1632
Shehab D, Elgazzar AH, Collier BD (2002) Heterotopic ossification. J Nucl Med 43(3):346–353
Brooke MM, Heard DL, Lateur BJ de et al (1991) Heterotopic ossification and peripheral nerve entrapment: early diagnosis and excision. Arch Phys Med Rehabil 72(6):425–429
Wharton GW, Morgan TH (1970) Ankylosis in the paralyzed patient. J Bone Joint Surg Am 52(1):105–112
Kolar J, Babicky A, Bibr B, Vrabec R (1971) Systemic effects of burns on bone mineral metabolism. Acta Chir Plast 13(3):133–140
Shafritz AB, Kaplan FS (1998) Differential expression of bone and cartilage related genes in fibrodysplasia ossificans progressiva, myositis ossificans traumatica, and osteogenic sarcoma. Clin Orthop Relat Res (346):46–52
Luu HH, Song WX, Luo X et al (2007) Distinct roles of bone morphogenetic proteins in osteogenic differentiation of mesenchymal stem cells. J Orthop Res 25(5):665–677
Chalmers J, Gray DH, Rush J (1975) Observations on the induction of bone in soft tissues. J Bone Joint Surg Br 57(1):36–45
Peterson SL, Mani MM, Crawford CM et al (1989) Postburn heterotopic ossification: insights for management decision making. J Trauma 29(3):365–369
Crawford CM, Varghese G, Mani MM, Neff JR (1986) Heterotopic ossification: are range of motion exercises contraindicated? J Burn Care Rehabil 7(4):323–327
Elledge ES, Smith AA, McManus WF, Pruitt BA Jr (1988) Heterotopic bone formation in burned patients. J Trauma 28(5):684–687
Koch BM, Wu CM, Randolph J, Eng GD (1992) Heterotopic ossification in children with burns: two case reports. Arch Phys Med Rehabil 73(11):1104–1106
Gaur A, Sinclair M, Caruso E et al (2003) Heterotopic ossification around the elbow following burns in children: results after excision. J Bone Joint Surg Am 85-A(8):1538–1543
Evans EB (1991) Heterotopic bone formation in thermal burns. Clin Orthop Relat Res (263):94–101
Tsionos I, Leclercq C, Rochet JM (2004) Heterotopic ossification of the elbow in patients with burns. Results after early excision. J Bone Joint Surg Br 86(3):396–403
Munster AM, Bruck HM, Johns LA et al (1972) Heterotopic calcification following burns: a prospective study. J Trauma 12(12):1071–1074
Summerfield SL, DiGiovanni C, Weiss AP (1997) Heterotopic ossification of the elbow. J Shoulder Elbow Surg 6(3):321–332
Evans EB, SMITH JR (1959) Bone and joint changes following burns; a roentgenographic study; preliminary report. J Bone Joint Surg Am 41–A(5):785–799
Garland DE, Hanscom DA, Keenan MA et al (1985) Resection of heterotopic ossification in the adult with head trauma. J Bone Joint Surg Am 67(8):1261–1269
Orzel JA, Rudd TG (1985) Heterotopic bone formation: clinical, laboratory, and imaging correlation. J Nucl Med 26(2):125–132
Gautschi OP, Cadosch D, Bauer S et al (2008) Heterotope Ossifikation – Von der Ätiologie zur aktuellen Therapie. Unfallchirurg 111(7):523–534
Puzas JE, Miller MD, Rosier RN (1989) Pathologic bone formation. Clin Orthop Relat Res (245):269–281
Garland DE (1991) A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res (263):13–29
Gaur A, Sinclair M, Caruso E et al (2003) Heterotopic ossification around the elbow following burns in children: results after excision. J Bone Joint Surg Am 85–A(8):1538–1543
Viola RW, Hanel DP (1999) Early „simple“ release of posttraumatic elbow contracture associated with heterotopic ossification. J Hand Surg 24(2):370–380
Neal BC, Rodgers A, Clark T et al (2000) A systematic survey of 13 randomized trials of non-steroidal anti-inflammatory drugs for the prevention of heterotopic bone formation after major hip surgery. Acta Orthop Scand 71(2):122–128
Wahl B, Grasshoff H, Meinecke I, Neumann HW (2002) Klinische und radiologische Ergebnisse der operativen Entfernung von periartikulären Ossifikationen nach Hüftendoprothese. Unfallchirurg 105(6):523–526
Romano CL, Duci D, Romano D et al (2004) Celecoxib versus indomethacin in the prevention of heterotopic ossification after total hip arthroplasty. J Arthroplasty 19(1):14–18
Padgett DE, Holley KG, Cummings M et al (2003) The efficacy of 500 CentiGray radiation in the prevention of heterotopic ossification after total hip arthroplasty: a prospective, randomized, pilot study. J Arthroplasty 18(6):677–686
Heyd R, Buhleier T, Zamboglou N (2009) Radiation therapy for prevention of heterotopic ossification about the elbow. Strahlenther Onkol 185(8):506–511
Pakos EE, Stafilas KS, Tsekeris PG et al (2009) Combined radiotherapy and indomethacin for the prevention of heterotopic ossification after total hip arthroplasty. Strahlenther Onkol 185(8):500–505
Siemers F, Lohmeyer JA, Machens HG et al (2007) Heterotope Ossifikationen – eine schwerwiegende Komplikation bei Brandverletzungen. Handchir Mikrochir Plast Chir 39:360–363
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Siemers, F., Stollwerck, P., Lohmeyer, J. et al. Heterotope Ossifikationen bei Schwerbrandverletzten. Chirurg 81, 647–652 (2010). https://doi.org/10.1007/s00104-009-1850-5
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DOI: https://doi.org/10.1007/s00104-009-1850-5