The Journal of Bone and Joint Surgery, Vol 70, Issue 8 1231-1237, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Heterotopic ossification as a complication of acetabular fracture. Prophylaxis with low-dose irradiation
MJ Bosse, A Poka, CM Reinert, F Ellwanger, R Slawson and ER McDevitt
Department of Orthopedic Surgery, United States Naval Hospital, Portsmouth, Virginia 23708.
In a retrospective review of thirty-seven patients who had operative
treatment for thirty-eight complex acetabular fractures, postoperative
low-dose irradiation was administered to seventeen patients (eighteen
fractures) to suppress heterotopic ossification. All of the patients had
been operated on through either an extended iliofemoral incision or a
modified extended iliofemoral incision. The prophylactic radiation was
administered using a low-dose protocol; most of the patients received 1,000
rads in 200-rad increments, starting on the third post-operative day. The
incidence of heterotopic ossification in the eighteen irradiated limbs was
much lower than in the twenty patients who comprised the control group (50
per cent compared with 90 per cent). Only two of the irradiated limbs had
Class-3 heterotopic ossification as described by Brooker et al., and no
patient had Class-4 (ankylosis of the hip). Of the twenty control-group
patients, ten had severe heterotopic ossification: Class 3 in seven and
Class 4 in three. The difference in the incidence of severe (Class-3 or 4)
heterotopic ossification between the two groups of patients was significant
(p less than 0.01).
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