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[Surgical resection of heterotopic ossification after open reduction internal fixation of acetabular fractures]
Xin-Bao Wu1, Ming-Hui Yang, Man-Yi Wang
1Department of Trauma and Orthopaedics, Fourth School of Medicine of Peking University, Beijing Jishuitan Hospital, Beijing 100035, China.
Objective:
To evaluate the clinical effect of surgical resection of the severe heterotopic ossification (HO) after the open reduction internal fixation (ORIF) of acetabular fractures.
Methods:
Five cases of severe HO after the ORIF of acetabular fractures were treated by surgical resection from October 2005 to April 2007. All patients were male, the average age was 34 years (22 to 45 years). The average time of HO after ORIF of acetabular fractures was 14.2 months (3 to 30 months). The original surgical approaches were: Kocher-Langenbeck approach as 4, ilioinguinal combined K-L approach as 1. According to the Brooker classification, there were 4 patients with IV degree and 1 with III degree. The average total movement for all the 5 patients was 8 degrees. All patients received one time radiation therapy before or after operation, the dosage was 7-8 Gy. The surgical approach was Kocher-Langenbeck for all patients. During operation the nerve stimulator was used to explore the sciatic nerve and carefully protected it, resected all HO bone and removed all implants. For one patient, because of confusion between femoral head and acetabulum, total hip replacement were performed. The joint exercise (passively and actively) began from the second day after operation, and at the same time, all patients took the indomethacin to prevent the occurrence of HO.
Results:
All patients were followed up for 4 to 22 months. There was no recurrence of HO, the average total movement for all the 5 patients was 160 degrees.
Conclusion:
Early surgical resection and combined with radiation and indomethacin for the severe HO after the ORIF of acetabular fractures can obtain excellent results.
