García-Manzanares MD, Medina-Gálvez N, Tornero-Jiménez D, Sunyer-Catllà M, González-Martínez R

Language: Spanish
References: 27
Page: 41-46
PDF size: 124.86 Kb.

ABSTRACT

Introduction and objectives: To evaluate the functional results in patients that underwent a surgical procedure to treat heterotopic ossification (HO). We have reviewed all the HO patients treated with surgery, between 1990 and 2005. Material and methods: A descriptive study with the following variables: age, sex, profession, risk factors, medical surgical treatments and joint balance measurement. Measurement of the Nottingham Health Profile, Visual Analogic Scale (VAS). In the patients with Traumatic Brain Injury (TBI): The Scale «Rancho Los Amigos». Results: 6 cases of HO had surgery. The average age was 43.66 ± 8.48 years, all of them were men, 50% had a qualified job and 50% were non-qualified. Risk factors: 66.6% HO in a different joint, 33.3% TBI, 16.6% AVC, 16.6% previous traumatism, 16.6% postraumatic arthritis and 16.6% mechanical ventilation. Medical treatments: 50% NSAIDS, 83.3% etridonate, 100% cinesitherapy, 50% electrotherapy and 33.3% used orthesis. Surgical technique: 83.3% excision of the HO, 50% freed of the soft parts, 33.3% capsulotomy, 16.6% cleaning of calcified clots and tissues and 16.6% arthrodesis. The average improvement in the joint balance after the surgery was 39.57°. We obtained an average of positive results in the Nottingham Health Profile of 19.72. Discussion: It must be considered the surgical option, if the medical and rehabilitation HO treatment does not obtain the desired results. When the candidates are properly select for surgery, the joint balance improvement, the pain improvement and the quality of life scales improvement are evident.

REFERENCES

1. Geschickter CF, Maseritz I. Myositis ossificans. J Bone Joint Surg Am 1983; 20: 661-674.

2. Dejerine A, Ceillier A. Para-osteo-arthropathies des paraplegigues par lesion medullarie; etude clinique et radiographique. Ann Med 1918; 5: 497.

3. Vanden L, Vanderstraeten: Heterotopic G. Ossification: a Review. J Rehabil Med 2005; 37(3): 129-136.

4. Garland DE, Blum CE, Waters RL. Periarticular heterotopic ossification in head injured adults. Incidence and location. J Bone Joint Surg A 1980; 62(7): 1143-1146.

5. Orzel JA, Rudd TG. Heterotopic bone formation: clinical, laboratory, and imaging correlation. J Nuclear Med 1985; 26(2): 125-132.

6. Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Rel Res 1990; 18: 13-29.

7. Garland DE. Surgical approaches for resection of heterotopic ossification in traumatic brain-injured adults. Clin Orthop 1991; 263: 59-70.

8. Freed JH, Hahn H, Menter R, Dillon T. The use of three phase bone scan in the early diagnosis of heterotopie ossification and in the evaluation of Didronel therapy. Paraplegia 1982; 20: 208-216.

9. Orzel JA, Rudd TG. Heterotopic bone formation: Clinical, laboratory, and imaging correlation. Journal of Nuclear Medicine 1985; 26(2): 125-132.

10. Pistarini C, Carlevatti S, Contardi A. The echographic diagnosis of neurogenic paraostearthropathias in myelosis patients. Giomale Italiano di Medicina del Lavoro 1993; 15(5-6): 159-163.

11. Essenwein SA, Sell S, Herr G, Gaissmaier C, Bamberg M, Mollen-Hoff G et al. Effects of single-dose versus fractionated irradiation on the suppression of heterotopic bone formation-an animal model-based follow-up study in rats. Arch Orthop Trauma Surg 2000; 120: 575-581.

12. Bergman SB, Yarkony GM, Stiens SA. Spinal cord injury rehabilitation. Medical complications. Arch of Phys Med and Rehab 1997; 78(3): 53-58.

13. Gennarelli TA. Heterotopic ossification. Brain Injury 1988; 2(2): 175-178.

14. Buschbacher R, McKinley W, Buschbacher L, Devaney CW, Coplin B. Warfarin in prevention of heterotopic ossification. Am J Phys Med and Rehab 1992; 71(2): 86-91.

15. Mital MA, Garber JE, Stinson JT. Ectopie bone formation in children and adolescents with head injuries: its management. J Ped Orthop 1987; 7(1): 83-90.

16. Banovac K. The effect of Etidronate on late development of heterotopic ossification after spinal cord injury. J Spinal Cord Med 2000; 23: 40-44.

17. Lipscomb AB, Thomas ED, Johnston RK. Treatment of myositis ossificans traumatic in athletes. Am J Sports Med 1976; 4(3): 11-20.

18. Sferopoulos NK, Anagnostopoulos D. Ectopic bone formation in a child with a head injury: complete regression after immobilization. Int Orthop 1997; 21(6): 412-414.

19. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Buschbacher RM, Dumitru D, Johnson EW, Matthews D, Sinaki M, ed. Phys Med and Rehab. 2nd ed. Philadelphia: WB Saunders Company, 1996: 792.

20. Van Kuijk A, Geurts A, Van Kuppevelt H. Neurogenic heterotopic ossification in spinal cord injury. Spinal Cord 2002; 40: 313-326.

21. Kjaersgaard-Andresen P, Schumidt SA, Pedersen NW, Kristesen SS, Pedersem P. Erythrocyte sedimentation rate and heterotopic bone formation after cementated total hip arthroplasty. Clin Orthop 1989; 248: 189-194.

22. Lazarus MD, Guttmann D, Rich CE, Keenan ME. Heterotopic ossification resection about the elbow. Neurorehabilitation 1999; 12: 145-153.

23. Gascon O, Didier CH, Rhenter JL, Minaire P. Possibilités du traitement chirurgical de paraostéoarthropathies neurogènes. Etude critique de 70 cas operas. Rey Chir Orthop 1978; 64: 375-390.

24. Ippolito E, Formisano R, Caterini R, Farsetti P, Penta F. Operative treatment of heterotopic hip ossification in patients with coma after brain injury. Clin Orthop 1999; 365: 130-138.

25. Moore KD, Goss K, Anglen JO. Indomethacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures: a randomized, prospective study. J Bone Joint Surg B 1988; 80(2): 259-263.

26. Garland DE, Houscom DA, Keenan MA, Smith C, Moore T. Resection of heterotopic ossification in the adult with head trauma. J Bone Joint Surg 1985; 67A: 1261-1269.

27. Melamed E, Robinson D: Brain injury-related heterotopic bone formation: treatment strategy and results. Am J Phys Med Rehabil 2002; 81(9): 670-674.