Heterotopic Ossification Following Traumatic and Combat-Related Amputations

Potter, Benjamin K.; Burns, Travis C.; Lacap, Anton P.; Granville, Robert R.; Gajewski, Donald A.
March 2007
Journal of Bone & Joint Surgery, American Volume;Mar2007, Vol. 89-A Issue 3, p476
Academic Journal
Background: Although infrequently reported in amputees previously, heterotopic ossification has proven to be a common and problematic clinical entity in our recent experience in the treatment of traumatic and combat-related amputations related to Operation Enduring Freedom and Operation Iraqi Freedom. The purpose of the present study was to report the prevalence of and risk factors for heterotopic ossification following trauma-related amputation as well as the preliminary results of operative excision. Methods: We identified 330 patients with a total of 373 traumatic and combat-related amputations who had been managed at our centers between September 11, 2001 and November 30, 2005. We reviewed the medical records and radiographs of 187 patients with 213 amputations who had adequate radiographic follow-up. Additional analysis was performed for twenty-four patients with twenty-five limbs that required excision of symptomatic lesions. The mechanism and zone of injury, amputation level, timing of excision, use of prophylaxis against recurrence, and other confounding variables were examined. Outcomes were assessed by determining clinical and radiographic recurrence rates, perioperative complications, preoperative and follow-up pain medication requirements, and the ability to be fit with a functional prosthesis. Results: Heterotopic ossification was present in 134 (63%) of 213 residual limbs, with twenty-five lesions requiring excision. A final amputation level within the zone of injury was a risk factor for both the development and the grade of heterotopic ossification (p < 0.05). A blast mechanism was predictive of occurrence (p < 0.05) but did not correlate with grade. All patients who had been managed with excision were tolerating the prosthetic limb at an average of twelve months of follow-up. Twenty-three limbs demonstrated no evidence of recurrence, and two limbs had development of clinically asymptomatic, radiographically minimal recurrences. Six patients experienced wound-related complications that required reoperation, and two patients required subsequent minor revision surgery. There was a significant decrease in the use of pain medication following surgery (p < 0.05). Conclusions: Heterotopic ossification following trauma-related amputation is more common than the literature would suggest, particularly following amputations that are performed within the initial zone of injury and those that are due to blast injuries. Many patients are asymptomatic or can be successfully managed with modification of the prosthesis. For patients with refractory symptoms, surgical excision is associated with low recurrence rates and decreased medication requirements, with acceptable complication rates.


Related Articles

  • New Campaign Stars recognize Multiple Deployments. J, Richard // All Hands;Jul2008, Issue 1096, p7 

    The article reports on the establishment of campaign stars for Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) designed to recognize support delivered to OEF and OIF for seven different service stages.

  • Bush Sends War Supplemental to Hill. Baumann, David // National Journal;3/29/2003, Vol. 35 Issue 13, p1006 

    Focuses on the supplemental spending legislation for the war in Iraq and homeland security sent by U.S. President George W. Bush to the Congress in March 2003. Allocation of the supplemental spending requested; Concerns of some legislators on the budget request.

  • Where to fight the war on terror -- over there, or here? Sowell, Thomas // Enterprise/Salt Lake City;7/23/2007, Vol. 37 Issue 3, p14 

    The author argues that the U.S. should continue fighting the war on terror in Iraq. The implications of the withdrawal of U.S. troops from Iraq are discussed. He describes the significance of the war in Iraq for terrorists. He comments on the impact of terrorist or Iranian control of Iraq on the...

  • The Motive for Terrorism That Officials Dare Not Acknowledge. Porter, Gareth // Foreign Policy in Focus;9/13/2011, p3 

    The article explores how the U.S. campaign in Iraq and Afghanistan is gaining support for jihadist movement. Citing intelligence reports, security experts state that the threat coming from self-radicalized cells will expand in the region and abroad. Surveys conducted in South Asia revealed that...

  • FROM THE ' OLD ' TO THE ' NEW ' SUSPECT COMMUNITY Examining the Impacts of Recent UK Counter-Terrorist Legislation. Pantazis, Christina; Pemberton, Simon // British Journal of Criminology;Sep2009, Vol. 49 Issue 5, p646 

    The 'war on terror' has emerged as the principal conflict of our time, where 'Islamic fanaticism' is identified as the greatest threat to Western liberal democracies. Within the United Kingdom, and beyond, this political discourse has designated Muslims as the new 'enemy within' -- justifying...

  • JUSTICE IN A TIME OF TERROR. Hudson, Barbara // British Journal of Criminology;Sep2009, Vol. 49 Issue 5, p702 

    The war on terror has seen the occupation of Iraq and Afghanistan; the use of torture on detainees in Guantanamo Bay; extension of periods of detention without trial, and increased levels of surveillance and control in the United Kingdom and the United States. Although being fought in the name...

  • Is Obama a Turkey or an Eagle? Rossiter, Caleb // Foreign Policy in Focus;10/28/2010, p4 

    The author reflects on the aggressive and anti-imperialist symbols of U.S. foreign policy, specifically the U.S. war on terror. He mentions the divide between the Democratic and Republican parties over how to combat the war on terror but not about the opposition of Islamist groups to U.S....

  • Tophatters Take It to the Enemy. Gordon, Robert // Wings of Gold;Winter2011, Vol. 36 Issue 4, p22 

    The article focuses on Tophatters, the U.S. Navy's strike fighter squadron VFA-14, that has faced two battles including operation New Dawn in Iraq and operation Enduring Freedom in Afghanistan. Comments on the awards won by the members of the squadron including CVW-9 Top Hook award and Top...

  • LETTERS. Gialousis, Caliope; Phelan, Bill; Smith, Linda M.; Pearson, Joe; Parker, Jim // Editor & Publisher;Apr2008, Vol. 141 Issue 4, p6 

    Several letters to editor are presented in response to articles in 2008 issues, including "From Spin Zone to War Zone," "Five Years Later: Pundits Who Were Wrong on Iraq," and an article on mass media's response to the 2007-2008 mortgage crisis.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics