Has the Proportion of Combat-Related Amputations That Develop Heterotopic Ossification Increased?

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Military Medicine

Background:

• Heterotopic ossification (HO) is a significant complication following traumatic amputations.
• Understanding HO prevalence and risk factors in combat casualties is crucial for optimizing care.

Purpose of the Study:

• To determine the incidence of HO in residual limbs of US service members with combat-related amputations.
• To analyze the injury profile associated with HO development.
• To assess the impact of multiple amputations on healthcare resource utilization.

Main Methods:

• Retrospective review of 471 consecutive patients with 714 combat-related amputations.
• Radiographic follow-up beyond 2 months post-injury for 439 amputations.
• Analysis of HO formation, grade, and correlation with injury type and patient factors.

Main Results:

• HO was observed in 91% of residual limbs (399/439), with 98% in transfemoral amputations.
• Dismounted improvised explosive device (IED) blast injuries showed higher HO rates (93%) compared to mounted IED blast injuries (82%).
• Increased number of amputations per patient correlated with higher utilization of blood products, ventilators, ICU, and hospital days.

Conclusions:

• HO prevalence in war-wounded amputees is high and increasing, linked to severe dismounted blast injuries.
• The findings highlight the need for targeted interventions and resource management for combat amputees.