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Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation

  • Symposium: Fractures of the Acetabulum
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Heterotopic ossification (HO) is a common complication of the operative treatment of acetabular fractures. Although the surgical approach has been shown to correlate with the development of ectopic bone, specific risk factors have not been elucidated.

Questions/purposes

The purposes of this study were to determine specific risk factors associated with the development of severe HO and the frequency with which patients develop severe HO after acetabular fracture fixation through an isolated Kocher-Langenbeck approach.

Methods

Using an institutional orthopaedic trauma database at a regional Level I trauma center, patients undergoing open treatment of acetabular fractures during the study period (January 2000 to January 2010) were identified. A review of medical records and imaging studies was performed on 508 patients who were treated by the senior author (MR) through an isolated Kocher-Langenbeck approach. During the study period, the senior author used indomethacin for HO prophylaxis in patients who had ipsilateral femur fracture treated with antegrade reamed medullary nailing or severe local soft tissue injury; 49 (10%) of the patients he treated with the Kocher-Langenbeck approach received prophylaxis, and they were excluded from this study, leaving a total of 459 patients who met inclusion criteria. Of those, 147 (29%) were lost to followup or did not have radiographs both before and at a minimum of 6 weeks (median, 1 week; range, 0–3 weeks), leaving 312 (61% of the patients treated with the Kocher-Langenbeck approach during this time) available for this analysis. Demographic data as well as information related to cause of injury, associated periacetabular findings, other system injuries, and treatment were gathered. Final followup radiographs were assessed for the presence of ectopic bone by two of the authors (TJO, AS) using the modified Brooker classification. Logistic regression was performed to identify possible predictors of development of severe ectopic bone.

Results

The only predictor we identified for the development of severe HO was the need for prolonged mechanical ventilation (odds ratio, 7.1; 95% confidence interval, 2.9–17.3; p = 0.001). Injury Severity Score, sex, presence of comminution, femoral head impaction, dislocation, degloving injury, debris in the joint, number of other fractures, and head and chest Abbreviated Injury Score > 2 did not correlate with severe HO. Severe HO (Brooker Class III or IV) developed in 38 of 312 patients (12%).

Conclusions

Patients with prolonged mechanical ventilation might benefit from HO prophylaxis given the increased risk of developing severe HO in this patient population. However, future prospective studies need to be performed to verify this finding given the fact that a considerable number of patients were prophylactically treated in this study.

Level of Evidence

Level IV, prognosticstudy. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Dr Suzette Miranda and Jessica Schisel for editing assistance.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359798, Seattle, WA, 98104, USA

    Reza Firoozabadi MD, MA, Alan Swenson MD & Julie Agel MA, ATC

  2. Reno Orthopaedic Clinic, Reno, NV, USA

    Timothy J. O’Mara MD

  3. Washington Hand Surgery, Bellevue, WA, USA

    John D. Beck MD

  4. Department of Orthopaedic Surgery, The University of Texas Medical School at Houston, Houston, TX, USA

    Milton Routt MD

Authors
  1. Reza Firoozabadi MD, MA
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  2. Timothy J. O’Mara MD
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  3. Alan Swenson MD
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  4. Julie Agel MA, ATC
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  5. John D. Beck MD
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  6. Milton Routt MD
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Corresponding author

Correspondence to Reza Firoozabadi MD, MA.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at Harborview Medical Center, Seattle, WA, USA.

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Firoozabadi, R., O’Mara, T.J., Swenson, A. et al. Risk Factors for the Development of Heterotopic Ossification After Acetabular Fracture Fixation. Clin Orthop Relat Res 472, 3383–3388 (2014). https://doi.org/10.1007/s11999-014-3719-2

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  • DOI: https://doi.org/10.1007/s11999-014-3719-2

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