Miss Nichola Foster^1,3, A/Prof Dale Edgar^2,3, W/Prof Fiona Wood^3,4, Dr Edward Raby^3,4, Dr Mark Fear³, A/Prof Nathan Pavlos⁵

¹School of Physiotherapy, The University Of Notre Dame, Fremantle, Perth, Australia, ²Burn Injury Research Node, Institute for Health Research, The University of Notre Dame , Fremantle, Perth , Australia, ³Burn Injury Research Unit and Fiona Wood Foundation, University of Western Australia, Nedlands, Perth, Australia, ⁴State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Perth, Australia, ⁵School of Biomedical Sciences, University of Western Australia, Nedlands, Perth, Australia

Abstract:

Heterotopic ossification (HO) is the abnormal formation of bone outside the skeleton, including soft tissues and joints. HO presents a barrier to rehabilitation for burn and trauma injured patients however, the prevalence and risk factors are poorly understood (Kornhaber et al. 2017). This study aimed to evaluate HO in trauma populations with respect to epidemiology and, to identify risk factors for developing HO in patients after burns and other trauma.

A retrospective audit of burn, neurological and orthopaedic trauma patients over an 11-year period was carried out at WA tertiary hospitals. Trauma patients diagnosed with HO (HO+) and matched controls (HO-) were identified using medical diagnostic codes. Demographic and clinical data were recorded and continuous and nominal variables were compared between HO+ and HO- groups. Univariate and multivariate techniques were used to identify HO risk factors.

We identified 103 HO+ patients of which, 74 had a clinical history of burns (n=22), neurological (n=34) or orthopaedic (n=18) trauma. Median inpatient length of stay was significantly higher in burns HO+ patients (116 days) than controls (41 days).  An outpatient diagnosis was significantly more frequent in the orthopaedic population (93.8%) than after burns (5.8%) and neurological injury (15%). Clinical suspicion of HO preceded radiological evidence at a median time of 38 days. HO developed radiologically 4.5 weeks earlier after burn than neurological injury, at a median time of 57 days.

Risk factor analyses are ongoing. Our findings may help clinicians predict patients at highest risk of developing HO after trauma and achieve an early and accurate diagnosis of HO.

1. Kornhaber, R, Foster, N, Edgar, D, Visentin, D, Ofir, E, Haik, J, & Harats, M 2017, ‘The development and impact of heterotopic ossification in burns: a review of four decades of research’, Scars, Burns & Healing, vol 3, no. 1, pp. 1-20.

Biography:

Nichola is a neurological physiotherapist and is undertaking a PhD through the School of Physiotherapy at The University of Notre Dame, Australia. Her research is investigating the prevalence, risk factors, prevention and treatment of heterotopic ossification after burn and other trauma.