Heterotopic ossification revisited: A 21-year surgical experience

John L. Hunt, Brett D. Arnoldo, Karen Kowalske, Phala Helm, Gary F. Purdue

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.

Original languageEnglish (US)
Pages (from-to)535-540
Number of pages6
JournalJournal of Burn Care and Research
Volume27
Issue number4
DOIs
StatePublished - Jul 2006

Fingerprint

Heterotopic Ossification
Elbow
Articular Range of Motion
Wound Infection
Activities of Daily Living
Forearm
Joints
Body Surface Area
Mechanical Ventilators
Burns
Hematoma
Intensive Care Units
Life Style
Hip
Length of Stay
Knee
Therapeutics
Transplants
Recurrence
Equipment and Supplies

ASJC Scopus subject areas

  • Emergency Medicine
  • Rehabilitation
  • Surgery

Cite this

Heterotopic ossification revisited : A 21-year surgical experience. / Hunt, John L.; Arnoldo, Brett D.; Kowalske, Karen; Helm, Phala; Purdue, Gary F.

In: Journal of Burn Care and Research, Vol. 27, No. 4, 07.2006, p. 535-540.

Research output: Contribution to journalArticle

@article{ebae92ae7d914b7b8e1cba5c86dc4cdd,
title = "Heterotopic ossification revisited: A 21-year surgical experience",
abstract = "Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55{\%} and 37{\%}, respectively. The elbow was the most frequent site (>90{\%}), and 44{\%} were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90{\%} of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75{\%} of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.",
author = "Hunt, {John L.} and Arnoldo, {Brett D.} and Karen Kowalske and Phala Helm and Purdue, {Gary F.}",
year = "2006",
month = "7",
doi = "10.1097/01.BCR.0000226023.58438.14",
language = "English (US)",
volume = "27",
pages = "535--540",
journal = "Journal of Burn Care and Research",
issn = "1559-047X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Heterotopic ossification revisited

T2 - A 21-year surgical experience

AU - Hunt, John L.

AU - Arnoldo, Brett D.

AU - Kowalske, Karen

AU - Helm, Phala

AU - Purdue, Gary F.

PY - 2006/7

Y1 - 2006/7

N2 - Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.

AB - Heterotopic ossification (HO) is an infrequently encountered complication of a burn. A retrospective review was undertaken to evaluate our treatment and results. Forty-two patients were identified with HO during 21 yrs. Mean age was 38 yrs. Mean total body surface area and third-degree burn were 55% and 37%, respectively. The elbow was the most frequent site (>90%), and 44% were bilateral. The next most common sites were shoulder, hip, knee, and forearm. Greater than 90% of patients had ventilator support and intensive care unit length of stay 58 and 79 days, respectively. HO was first suspected by decreased range of motion, painful and/or swollen joint, or a nerve deficit. Conventional radiographs were used to confirm the clinical diagnosis. The majority of burns overlying joints with HO were associated with prolonged wound closure because of depth, wound infection, or graft loss. Mean day of diagnosis was 71 days (range, 21-134). Excision of HO was undertaken only when range of motion compromised activities of daily living. Surgery successfully improved range of motion in all cases. The mean elbow arc of motion before and after surgery was 52 degrees and 119 degrees (range, 30-180 degrees), respectively. Seventy percent of elbows were ankylosed. A continuous passive motion device was instituted immediately postoperatively. Local postoperative complications included hematoma, wound dehiscence, infection, and nerve deficit. Maintaining range of motion was difficult for 75% of patients. Symptomatic recurrence of HO occurred in four elbows and one forearm. Because the cause(s) are unknown, prevention is impossible; once diagnosed, medical treatment is problematic and spontaneous resolution is infrequent. Surgery continues to be the recommended treatment when activities of daily living or life style are affected.

UR - http://www.scopus.com/inward/record.url?scp=33749432433&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749432433&partnerID=8YFLogxK

U2 - 10.1097/01.BCR.0000226023.58438.14

DO - 10.1097/01.BCR.0000226023.58438.14

M3 - Article

C2 - 16819361

AN - SCOPUS:33749432433

VL - 27

SP - 535

EP - 540

JO - Journal of Burn Care and Research

JF - Journal of Burn Care and Research

SN - 1559-047X

IS - 4

ER -