Slovenská chirurgia 1-2/2020
Risk factors and prophylaxis of heterotopic ossifications after surgical treatment of acetabular posterior wall fractures
Aim of study: The incidence of heterotopic ossifications (HO) after surgical treatment of acetabular fractures is one of the common complications. The risk factors and prophylaxis effectiveness are still under debate. The aim of the study was to identify risk factors for HO formation and to evaluate the efficacy of the pharmacological HO prophylaxis in patients after acetabular surgery. Methodology: The retrospective study included all adult patients who were surgically treated at the Department of Trauma Surgery UNLP in Košice from 1.1.1998 to 31.12.2013 for non-pathological fracture of the posterior wall of the acetabulum (AO/OTA 62A1), transverse acetabular fracture with associated posterior wall fracture (AO/OTA 62B1) or acetabular posterior collum fracture with associated posterior wall fracture (AO/OTA 62A2.3). Patient‘s radiograph was used to assess HO presence and extent at least 3 months after surgery, or the degree of HO was determined from the patient‘s medical record. Information on pharmacological HO prophylaxis and other parameters was also obtained from patient medical records. Results: During the study HO occurred in 50 (61%) out of the 82 patients. Brooker‘s HO stage I and II was present in 41 (50%) patients. Clinically severe stage III was found in 9 (11%) patients. Pharmacological prophylaxis of HO was used in 36 (44%) patients, and its use did not reduce the incidence of HO (p=0.63). Heterotopic ossifications were more frequent in patients who underwent mechanical lung ventilation after injury (p = 0.04) and patients with HO had a higher mean ISS score [10.8 (SD 7.5) vs 7.6 (4.4), p = 0.03]. Conclusion: We identified the use of mechanical lung ventilation after injury and higher ISS as risk factors associated with HO formation after acetabular fractures. The use of pharmacological prophylaxis did not reduce the incidence of HO.
Keywords: Heterotopic ossifications, risk factors, preven
