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2015 ; 16
(ä): 313
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Current therapeutic strategies of heterotopic ossification--a survey amongst
orthopaedic and trauma departments in Germany
#MMPMID26494270
Winkler S
; Wagner F
; Weber M
; Matussek J
; Craiovan B
; Heers G
; Springorum HR
; Grifka J
; Renkawitz T
BMC Musculoskelet Disord
2015[Oct]; 16
(ä): 313
PMID26494270
show ga
BACKGROUND: Heterotopic ossification (HO) is a complication after tissue trauma,
fracture and surgery (i.e. total hip arthroplasty). Prophylaxis is the most
effective therapy. If HO formations become symptomatic and limit patients'
quality of life, revision surgery is indicated and is usually combined with a
perioperative oral prophylaxis (NSAIDs) and/or irradiation. However, a long-term
use of NSAIDs can induce gastro-intestinal or cardiac side-effects and possible
bony non-unions during fracture healing. Subject of this study was to assess the
current status of HO prophylaxis after injuries or fractures and to evaluate
current indications and strategies for excision of symptomatic HO. METHODS:
Between 2013 and 2014, a questionnaire was sent to 119 orthopaedic and trauma
surgery departments in Germany. Participation was voluntary and all acquired data
was given anonymously. RESULTS: The cumulative feedback rate was 71 %. Trauma and
orthopaedic surgery departments in Germany recommend oral HO prophylaxis after
acetabulum and femoral neck fractures, elbow dislocation, and fracture or
dislocation of the radial head. Pain upon movement and an increasing loss of
range of motion in the affected joint are considered to be clear indications for
HO surgery. A partial removal of ROM-limiting HO formations was also considered
important. The vast majority of all departments include perioperative oral HO
prophylaxis and/or irradiation if surgical HO removal is planned. The choice and
duration of NSAIDs is highly variable. CONCLUSION: HO is of clinical significance
in current traumatology and orthopaedics. Certain fractures and injuries are
prone to HO, and prophylactic measures should be taken. The respondents in this
survey assessed current therapeutic strategies for HO formations similarly. These
concepts are in line with the literature. However, the duration of perioperative
oral HO prophylaxis varied greatly among the specialist centres. This is
significant as a long-term use of NSAIDs fosters a potential risk for the
patients' safety and could influence the clinical outcome. National and
international guidelines need to be developed to further reduce HO rates and
improve patients' safety in trauma and orthopaedic surgery.
|Humans
[MESH]
|Orthopedics/statistics & numerical data
[MESH]
|Ossification, Heterotopic/*prevention & control
[MESH]