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Link Between Clinical Predictors of Heterotopic Ossification and Histological Analysis in Combat-Injured Service Members.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Isaacson, B. M. Potter, B. K. Bloebaum, R. D. Epperson, R. T. Kawaguchi, B. S. Swanson, T. M. Pasquina, P. F.
Description	Author Affiliation: Isaacson BM ( The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland brad.isaacson.ctr@usuhs.edu.); Potter BK ( Departments of Orthopaedics (B.K.P.) and Rehabilitation (P.F.P.), Walter Reed National Military Medical Center, Bethesda, Maryland Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland.); Bloebaum RD ( Bone & Joint Research Laboratory, Department of Veterans Affairs, Salt Lake City, Utah Departments of Bioengineering and Biology, University of Utah, Salt Lake City, Utah.); Epperson RT ( Bone & Joint Research Laboratory, Department of Veterans Affairs, Salt Lake City, Utah.); Kawaguchi BS ( Bone & Joint Research Laboratory, Department of Veterans Affairs, Salt Lake City, Utah.); Swanson TM ( The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland.); Pasquina PF ( The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences, Bethesda, Maryland Departments of Orthopaedics (B.K.P.) and Rehabilitation (P.F.P.), Walter Reed National Military Medical Center, Bethesda, Maryla)
Abstract	BACKGROUND: Heterotopic ossification (HO) is a debilitating condition that occurs following traumatic injury and may restrict range of motion and delay rehabilitation. The timing and efficacy of surgical resection have varied widely, and there is a gap in knowledge between clinical predictors of HO recurrence and histological analysis. METHODS: Thirty-three service members seen at Walter Reed National Military Medical Center for symptomatic HO were enrolled in an institutional review board-approved study. Participants took oxytetracycline on four scheduled days prior to HO resection to determine the mineral apposition rate (bone growth rate). RESULTS: Detailed histological analyses included scanning electron microscopy with backscattered electron imaging and light microscopy. Data indicated that the mineral apposition rate of trauma-induced HO was approximately 1.7 µm/day at the time of operative intervention, which was 1.7 times higher than the rate in non-pathological human bone. The mineral apposition rate and postoperative alkaline phosphatase values were demonstrated to be positively and significantly related (ρ = 0.509, p = 0.026, n = 19). When the analysis was limited to patients with no more than a two-year period from injury to excision (thereby removing outliers who had a longer time period than their counterparts) and traumatic brain injury and nonsteroidal anti-inflammatory drugs (known correlates with HO development) were controlled for in the statistical analysis, the mineral apposition rate and recurrence severity were significantly related (ρ = -0.572, p = 0.041, n = 11). CONCLUSIONS: Data demonstrated a link between benchtop research and bedside care, with the mineral apposition rate elevated in patients with HO and correlated with recurrence severity; however, a larger sample size and more clinical factors are needed to refine this model. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
File Format	HTM / HTML
ISSN	00219355
Issue Number	8
Volume Number	98
e-ISSN	15351386
Journal	The Journal of Bone and Joint Surgery-American Volume
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2016-04-20
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Orthopedic surgery Ossification, Heterotopic Pathology Surgery Adult Bone Remodeling Female Humans Male Military Personnel Etiology Prognosis Prospective Studies War-related Injuries Complications Journal Article
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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