A comparison of contracture severity at acute discharge in patients with and without heterotopic ossification: A burn model system national database study

Miranda L. Yelvington, Matthew Godleski, Austin F. Lee, Jeremy Goverman, David N. Herndon, Oscar E. Suman, Karen J Kowalske, Radha Holavanahalli, Nicole S. Gibran, Peter C. Esselman, Laura C. Simko, Colleen M. Ryan, Jeffrey C. Schneider

Research output: Contribution to journalArticle

Abstract

This study assesses the association between heterotopic ossification and upper extremity contracture by comparing goniometric measured active range of motion outcomes of patients with and without heterotopic ossification. Data were obtained from the Burn Model System National Database between 1994 and 2003 for patients more than 18 years with elbow contracture at acute discharge. Absolute losses in elbow range of motion were compared for those with and without radiologic evidence of heterotopic ossification (location undefined) and were further examined by burn size subgroups using Wilcoxon rank-sum test. Differences in elbow range of motion were estimated using regression models, adjusted for demographic and clinical variables. Loss of range of motion of shoulder, wrist, forearm, and hand were also compared. From 407 instances of elbow contracture, the subjects with heterotopic ossification were found to have greater median absolute loss of elbow flexion among all survivors (median 50° [IQR 45°] vs 20° [30°], P < .0001), for the 20 to 40% total body surface area burn subgroup (70° [20°] vs 20° [30°], P = .0008) and for the >40% subgroup (50° [45°] vs 30° [32°], P = .03). The adjusted estimate of the mean difference in the absolute loss of elbow flexion between groups was 23.5° (SE ±7.2°, P = .0013). This study adds to our understanding of the potential effect of heterotopic ossification on upper extremity joint range of motion, demonstrating a significant association between the presence of heterotopic ossification and elbow flexion contracture severity. Further study is needed to determine the functional implications of heterotopic ossification and develop treatment protocols.

Original languageEnglish (US)
Pages (from-to)349-354
Number of pages6
JournalJournal of Burn Care and Research
Volume40
Issue number3
DOIs
StatePublished - Jan 1 2019

Fingerprint

Heterotopic Ossification
Patient Discharge
Contracture
Elbow
Articular Range of Motion
Databases
Nonparametric Statistics
Upper Extremity
Clinical Protocols
Wrist
Forearm
Survivors
Hand
Demography

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

A comparison of contracture severity at acute discharge in patients with and without heterotopic ossification : A burn model system national database study. / Yelvington, Miranda L.; Godleski, Matthew; Lee, Austin F.; Goverman, Jeremy; Herndon, David N.; Suman, Oscar E.; Kowalske, Karen J; Holavanahalli, Radha; Gibran, Nicole S.; Esselman, Peter C.; Simko, Laura C.; Ryan, Colleen M.; Schneider, Jeffrey C.

In: Journal of Burn Care and Research, Vol. 40, No. 3, 01.01.2019, p. 349-354.

Research output: Contribution to journalArticle

Yelvington, ML, Godleski, M, Lee, AF, Goverman, J, Herndon, DN, Suman, OE, Kowalske, KJ, Holavanahalli, R, Gibran, NS, Esselman, PC, Simko, LC, Ryan, CM & Schneider, JC 2019, 'A comparison of contracture severity at acute discharge in patients with and without heterotopic ossification: A burn model system national database study', Journal of Burn Care and Research, vol. 40, no. 3, pp. 349-354. https://doi.org/10.1093/jbcr/irz031
Yelvington, Miranda L. ; Godleski, Matthew ; Lee, Austin F. ; Goverman, Jeremy ; Herndon, David N. ; Suman, Oscar E. ; Kowalske, Karen J ; Holavanahalli, Radha ; Gibran, Nicole S. ; Esselman, Peter C. ; Simko, Laura C. ; Ryan, Colleen M. ; Schneider, Jeffrey C. / A comparison of contracture severity at acute discharge in patients with and without heterotopic ossification : A burn model system national database study. In: Journal of Burn Care and Research. 2019 ; Vol. 40, No. 3. pp. 349-354.
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AU - Kowalske, Karen J

AU - Holavanahalli, Radha

AU - Gibran, Nicole S.

AU - Esselman, Peter C.

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N2 - This study assesses the association between heterotopic ossification and upper extremity contracture by comparing goniometric measured active range of motion outcomes of patients with and without heterotopic ossification. Data were obtained from the Burn Model System National Database between 1994 and 2003 for patients more than 18 years with elbow contracture at acute discharge. Absolute losses in elbow range of motion were compared for those with and without radiologic evidence of heterotopic ossification (location undefined) and were further examined by burn size subgroups using Wilcoxon rank-sum test. Differences in elbow range of motion were estimated using regression models, adjusted for demographic and clinical variables. Loss of range of motion of shoulder, wrist, forearm, and hand were also compared. From 407 instances of elbow contracture, the subjects with heterotopic ossification were found to have greater median absolute loss of elbow flexion among all survivors (median 50° [IQR 45°] vs 20° [30°], P < .0001), for the 20 to 40% total body surface area burn subgroup (70° [20°] vs 20° [30°], P = .0008) and for the >40% subgroup (50° [45°] vs 30° [32°], P = .03). The adjusted estimate of the mean difference in the absolute loss of elbow flexion between groups was 23.5° (SE ±7.2°, P = .0013). This study adds to our understanding of the potential effect of heterotopic ossification on upper extremity joint range of motion, demonstrating a significant association between the presence of heterotopic ossification and elbow flexion contracture severity. Further study is needed to determine the functional implications of heterotopic ossification and develop treatment protocols.

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