Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

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Heterotopic ossification in combat amputees from
Afghanistan and Iraq wars Five case histories
and results from a small series of patients

• Ted Melcer, PhD Brian Belnap, DO G . Jay
  Walker, BA Paula Konoske, PhD Michael
  Galarneau, MS

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Heterotopic Ossification (HO)Definition Excess
bone growth in soft tissues.

• Study Aim
• Describe radiographic and symptomatic evidence
  of HO in 27 OIF/OEF (Iraq/Afghanistan) combat
  amputees.
• Relevance
• HO frequently occurs in residual limbs of combat
  amputees.
• Resulting skin breakdown and pain can interfere
  with prosthetic use and walking, thereby delaying
  rehabilitation.

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Case Studies Radiographs
HO after elective, delayed transtibial
amputation. Prosthetic adjustments were
unsuccessful, and surgical excision reduced pain
and restored function.
Moderate HO in transfemoral amputee caused pain,
which was managed by prosthetic adjustments. HO
benefited prosthetic suspension in this case.
Moderate HO in transfemoral amputee caused no
pain or interference with prosthetic use.
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Radiographic and Symptomatic Evidence of HO (25
limbs)
Symptoms HO in Radiograph HO in Radiograph
Symptoms Yes None or Mild
Yes n 10 n 0
No n 5 n 10
5 of the 15 patients who showed HO in their
radiographs did not report symptoms
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Conclusions

• HO impact on pain, prosthetic use, and walking
• Depends on location of HO relative to
  pressure-sensitive and pressure-tolerant areas of
  residual limb.
• 1/3 of patients who had radiographic evidence of
  HO reported no symptoms.
• In rare cases, HO might benefit prosthetic
  fitting (suspension).
• Prophylactic medications
• Medications such as nonsteroidal,
  anti-inflammatory agents have been used as HO
  prophylaxis in combat amputees without other
  significant injuries. However, evidence of their
  effectiveness in combat amputees is inconclusive.
• Surgical excision
• Considered a final option after prosthetic
  adjustments must weigh risks and benefits of
  additional surgery.