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Heterotopic Ossification in Patients with Burns: a Systematic Literature Review

Abstract

Purpose of Review

The aim of this literature review is to review and join case studies and reports of heterotopic ossification development in patients sustaining burn injuries.

Recent Findings

The authors conducted a systematic literature search in PubMed, Cochrane library, EMBASE, and Scopus and reviewed cases from 1961 to 2020 of heterotopic ossification development in patients after burn injuries; the search included only publication in the English language.

The authors found 37 publications of heterotopic ossification in patients sustaining burn injuries, reporting a total of 530 cases, from 1961 to 2020.

The average total body surface affected (TBSA) by burns of patients in this review ranged from 8 to 95%, with an average TBSA of 43.4%. Two hundred and fifty-four patients (93.4%) suffered burns from thermal origin and 18 patients (6.6%) suffered from burns of high-voltage electrical burns.

Six hundred and fifty-four joints were reported to develop heterotopic ossification. The most commonly affected joint was the elbow (503/654), followed by the shoulder (37/654), knee (27/654), and hip (21/654).

Surgical procedures were performed in 245 patients, with an average pre-operative and post-operative joint range of motion (ROM) of 22.1° (range 0–105°) and 80.6° (range 0–160°), respectively.

Summary

Heterotopic ossification is a condition impairing joint function and range of movement, developing in patients sustaining severe burn injuries. Better understanding of the pathogenesis and contributing factors are crucial for providing proper treatment and restoring range of motion in affected patient joints.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Dejerine M, Ceillier A, Dejerine Y. Para-osteo-arthropathies des paraplegiques par lesion medullaire: Etude anatomique et histologique. Rev Neurol. 1919;26:399–407.

    Google Scholar 

  2. Richards AM, Klaassen MF. Heterotopic ossification after severe burns: a report of three cases and review of the literature. Burns: J Int Soc Burn Injuries. 1997;23(1):64–8. https://doi.org/10.1016/s0305-4179(96)00074-5.

    CAS  Article  Google Scholar 

  3. Rashid U, Bari A, Maqsood A, et al. Fibrodysplasia Ossificans Progressiva. Journal of the College of Physicians and Surgeons-Pakistan: JCPSP. 2016;26(2):154–5.

    PubMed  Google Scholar 

  4. Chalmers J, Gray DH, Rush J. Observations on the induction of bone in soft tissues. The Journal of bone and joint surgery British volume. 1975;57(1):36–45.

    CAS  Article  Google Scholar 

  5. Klein MB, Logsetty S, Costa B, et al. Extended time to wound closure is associated with increased risk of heterotopic ossification of the elbow. J Burn Care Res. 2007;28(3):447–50.

    Article  Google Scholar 

  6. Virbicky B. Post-burn heterotopic joint ossifications. Ann Burns Fire Disasters. 1991;4:161–4.

    Google Scholar 

  7. Chen HC, Yang JY, Chuang SS, Huang CY, Yang SY. Heterotopic ossification in burns: our experience and literature reviews. Burns. 2009;35(6):857–62. https://doi.org/10.1016/j.burns.2008.03.002. Recognized the possible development of Heterotopic Ossification in burns of smaller scale, demonstrating reports in injuries a small as 8% TBSA.

    Article  PubMed  Google Scholar 

  8. Foster N, Kornhaber R, McGarry S, et al. Heterotopic Ossification in adults following a burn: A phenomenological analysis. Burns. 2017;43(6):1250–62. https://doi.org/10.1016/j.burns.2017.03.001.

    Article  PubMed  Google Scholar 

  9. Mujtaba B, Taher A, Fiala MJ, et al. Heterotopic ossification: radiological and pathological review. Radiol Oncol. 2019;53(3):275–284. Published 2019 Sep 24. https://doi.org/10.2478/raon-2019-0039Described the radiological findings typically associated with the development of HO in patients with burns. Their study improves diagnosis and facilitates the treatment and management of the complication.

  10. Brownley RC, Agarwal S, Loder S, et al. Characterization of Heterotopic Ossification Using Radiographic Imaging: Evidence for a Paradigm Shift. PLoS ONE. 2015;10(11): e0141432. https://doi.org/10.1371/journal.pone.0141432.PMID:26544555;PMCID:PMC4636348.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Meyers C, Lisiecki J, Miller S, et al. Heterotopic Ossification: A Comprehensive Review. JBMR Plus. 2019;3(4):e10172. https://doi.org/10.1002/jbm4.10172 (Published 2019 Feb 27).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Balboni TA, Gobezie R, Mamon HJ. Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys. 2006;65(5):1289–99. https://doi.org/10.1016/j.ijrobp.2006.03.053 (PMID: 16863921).

    Article  PubMed  Google Scholar 

  13. Singh RS, et al. The predictive value of creatine phosphokinase and alkaline phosphatase in identification of heterotopic ossification in patients after spinal cord injury. Archives of physical medicine and rehabilitation. 2003;84(11):1584–8.

    Article  Google Scholar 

  14. Yang SC, Chen AC, Chao EK, et al. Early surgical management for heterotopic ossification about the elbow presenting as limited range of motion associated with ulnar neuropathy. Chang Gung Med J. 2002;25(4):245–52.

    PubMed  Google Scholar 

  15. Peters WJ. Heterotopic ossification: can early surgery be performed, with a positive bone scan? J Burn Care Rehabil. 1990;11(4):318–21. https://doi.org/10.1097/00004630-199007000-00009.

    CAS  Article  PubMed  Google Scholar 

  16. Walczak BE, Johnson CN, Matthew Howe B. Myositis ossificans. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2015;23(10):612–22.

    Article  Google Scholar 

  17. Zeckey C et al. "Heterotopic ossifications following implant surgery—epidemiology, therapeutical approaches and current concepts." Seminars in immunopathology. Vol. 33. No. 3. Springer-Verlag, 2011.

  18. Joice M, Vasileiadis GI, Amanatullah DF. Non-steroidal anti-inflammatory drugs for heterotopic ossification prophylaxis after total hip arthroplasty: a systematic review and meta-analysis. The bone & joint journal. 2018;100-B(7):915–22. https://doi.org/10.1302/0301-620X.100B7.BJJ-2017-1467.R1.

    CAS  Article  Google Scholar 

  19. Zhu XT, Chen L, Lin JH (2018) Selective COX-2 inhibitor versus non-selective COX-2 inhibitor for the prevention of heterotopic ossification after total hip arthroplasty: Ameta-analysis. Medicine (Baltimore). 2018:97(31):e11649. https://doi.org/10.1097/MD.0000000000011649.

  20. Cooley LM, Goss RJ. The effects of transplantation and x-irradiation on the repair of fractured bones. Am J Anat. 1958;102(2):167–81. https://doi.org/10.1002/aja.1001020202.

    CAS  Article  PubMed  Google Scholar 

  21. Craven PL, Urist MR. Osteogenesis by radioisotope labelled cell populations in implants of bone matrix under the influence of ionizing radiation. Clin Orthop Relat Res. 1971;76:231–43. https://doi.org/10.1097/00003086-197105000-00030.

    CAS  Article  PubMed  Google Scholar 

  22. Cadieux CL, DesRosiers C, McMullen K. Risks of secondary malignancies with heterotopic bone radiation therapy for patients younger than 40 years. Medical dosimetry: official journal of the American Association of Medical Dosimetrists. 2016;41(3):212–5. https://doi.org/10.1016/j.meddos.2016.02.001.

    Article  Google Scholar 

  23. Carano ASJPH, Teitelbaum SL, Konsek JD, et al. Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro. J Clin Investig. 1990;85(2):456–61.

    CAS  Article  Google Scholar 

  24. Rodan GA. Mechanisms of action of bisphosphonates. Annu Rev Pharmacol Toxicol. 1998;38(1):375–88.

    CAS  Article  Google Scholar 

  25. Lippin Y, Shvoron A, Faibel M, et al. Vocal cords dysfunction resulting from heterotopic ossification in a patient with burns. J Burn Care Rehabil. 1994;15(2):169–73. https://doi.org/10.1097/00004630-199403000-00012.

    CAS  Article  PubMed  Google Scholar 

  26. Banovac K, Sherman AL, Estores IM, et al. Prevention and treatment of heterotopic ossification after spinal cord injury. J Spinal Cord Med. 2004;27(4):376–82. https://doi.org/10.1080/10790268.2004.11753775.

    Article  PubMed  Google Scholar 

  27. Banovac K, Gonzalez F, Wade N, et al. Intravenous disodium etidronate therapy in spinal cord injury patients with heterotopic ossification. Paraplegia. 1993;31(10):660–6. https://doi.org/10.1038/sc.1993.106.

    CAS  Article  PubMed  Google Scholar 

  28. Thomas BJ, Amstutz HC. Results of the administration of diphosphonate for the prevention of heterotopic ossification after total hip arthroplasty. J Bone Joint Surg Am. 1985;67(3):400–3.

    CAS  Article  Google Scholar 

  29. Thomas BJ, Amstutz HC. Prevention of heterotopic bone formation: clinical experience with diphosphonates. Hip. 1987:59–69.

  30. Haran M, Bhuta T, Lee B. Pharmacological interventions for treating acute heterotopic ossification. Cochrane Database Syst Rev. 2004;(4):CD003321. https://doi.org/10.1002/14651858.CD003321.pub3. Update in: Cochrane Database Syst Rev. 2010;(5):CD003321.

  31. Teasell RW, Mehta S, Aubut JL, Ashe MC, Sequeira K, Macaluso S, Tu L. SCIRE Research Team. A systematic review of the therapeutic interventions for heterotopic ossification after spinal cord injury. Spinal Cord. 2010; 48(7):512–21. https://doi.org/10.1038/sc.2009.175

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Correspondence to Ron Skorochod.

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Skorochod, R., Nesher, G. & Gronovich, Y. Heterotopic Ossification in Patients with Burns: a Systematic Literature Review. Curr Phys Med Rehabil Rep (2022). https://doi.org/10.1007/s40141-022-00356-5

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  • DOI: https://doi.org/10.1007/s40141-022-00356-5

Keywords

  • Burns
  • Heterotopic ossification
  • Plastic surgery