This Article Full Text Full Text (PDF) CME: Take the exams for this article: Trauma Test 17: Spring 2007 (publication date May 15, 2007; expiration date... CME 1: January, February, March 2007 (publication date April 5, 2007; expir... [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Potter, B. K. Articles by Gajewski, D. A. Search for Related Content PubMed Articles by Potter, B. K. Articles by Gajewski, D. A. Related Collections Adult Trauma Rehabilitation Social Bookmarking             What's this?

Heterotopic Ossification Following Traumatic and Combat-Related Amputations

Prevalence, Risk Factors, and Preliminary Results of Excision

¹ Orthopaedic Surgery (B.K.P., A.P.L., and D.A.G.) and Amputee (D.A.G.) Services, Department of Orthopaedics and Rehabilitation, Walter Reed Army Medical Center, 6900 Georgia Avenue N.W., Building 2, Clinic 5A, Washington, DC 20307. E-mail address for B.K. Potter: Benjamin.Potter{at}na.amedd.army.mil
² Orthopaedic Surgery (T.C.B. and R.R.G.) and Amputee (R.R.G.) Services, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200

Investigation performed at the Walter Reed Army Medical Center, Washington, DC, and Brooke Army Medical Center, Fort Sam Houston, Texas

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the United States Government. All authors are employees of the United States government. This work was prepared as part of their official duties and as such, there is no copyright to be transferred.

Methods: We identified 330 patients with a total of 373 traumatic and combat-related amputations who had been managed at our centers between September 11, 2001 and November 30, 2005. We reviewed the medical records and radiographs of 187 patients with 213 amputations who had adequate radiographic follow-up. Additional analysis was performed for twenty-four patients with twenty-five limbs that required excision of symptomatic lesions. The mechanism and zone of injury, amputation level, timing of excision, use of prophylaxis against recurrence, and other confounding variables were examined. Outcomes were assessed by determining clinical and radiographic recurrence rates, perioperative complications, preoperative and follow-up pain medication requirements, and the ability to be fit with a functional prosthesis.

Results: Heterotopic ossification was present in 134 (63%) of 213 residual limbs, with twenty-five lesions requiring excision. A final amputation level within the zone of injury was a risk factor for both the development and the grade of heterotopic ossification (p < 0.05). A blast mechanism was predictive of occurrence (p < 0.05) but did not correlate with grade. All patients who had been managed with excision were tolerating the prosthetic limb at an average of twelve months of follow-up. Twenty-three limbs demonstrated no evidence of recurrence, and two limbs had development of clinically asymptomatic, radiographically minimal recurrences. Six patients experienced wound-related complications that required reoperation, and two patients required subsequent minor revision surgery. There was a significant decrease in the use of pain medication following surgery (p < 0.05).

Conclusions: Heterotopic ossification following trauma-related amputation is more common than the literature would suggest, particularly following amputations that are performed within the initial zone of injury and those that are due to blast injuries. Many patients are asymptomatic or can be successfully managed with modification of the prosthesis. For patients with refractory symptoms, surgical excision is associated with low recurrence rates and decreased medication requirements, with acceptable complication rates.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				C. T. Born, S. M. Briggs, D. L. Ciraulo, E. R. Frykberg, J. S. Hammond, A. Hirshberg, D. W. Lhowe, P. A. O'Neill, and J. Mead Disasters and Mass Casualties: II. Explosive, Biologic, Chemical, and Nuclear Agents J. Am. Acad. Ortho. Surg., August 1, 2007; 15(8): 461 - 473. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.