Prevention of heterotopic ossification after burns, a systematic review

Alexander Murray-Douglass¹, John Panizza Elizabeth Vujcich
¹Royal Brisbane And Women’s Hospital, Herston, QLD, Australia
²Princess Alexandra Hospital, Woolloongabba, QLD, Australia

Abstract

Purpose:
Heterotopic ossification (HO) can complicate recovery after burns. The elbow is most afflicted, in up to a quarter of patients following upper limb burns. Treatment often involves HO excision but prevention usually revolves around medication and radiation. This review aimed to determine if prevention of HO with radiotherapy was superior to medication with respect to HO recurrence and range of motion (ROM) at joints.

Methodology:
This prospectively registered, PRISMA-driven systematic review searched five databases. All full studies reporting prevalence of HO, treatment of HO or prevention of HO were included in qualitative synthesis.

Results:
48 articles reporting post-burn HO in 395 patients were included. Two studies reported primary prevention of HO, with etidronate sodium (EDHP) and non-steroidal anti-inflammatory drugs. EDHP may have increased the likelihood of HO formation. 12 articles reported secondary prevention of HO after excision. Three articles reported a mixture of medical and radiation prevention, two reported just medical prevention and five articles reported radiation for secondary prevention of HO. Indomethacin, diclofenac and piroxicam were used. Radiation was given immediately prior to, or after, surgery. Doses ranged from 700 centigray in a single fraction to 20 gray in 10 fractions. Recurrence was variably reported.

Conclusion:
HO is a potentially disabling complication of severe burns that can worsen function in a contracted joint. Treatment of the HO lesion with excision seems to restore function but secondary prevention of recurrence is poorly utilised. Variable protocols for medical and radiation therapy are reported.

Biography

Alex is a Plastic Surgery PHO in Brisbane who is keen on progressing surgical research. He has a keen interest in burn surgery and reconstruction.