Prophylaxis of heterotopic ossification in patients sedated after polytrauma : medical and ethical considerations.
OBJECTIVE
Heterotopic ossification (HO) often follows acetabular fractures after multitrauma. Irradiation is a mean for prophylaxis. We established a standard procedure in our hospital for patients under sedation, when obtaining informed consent for HO prophylaxis is impossible.


METHODS
We reviewed current scientific evidence, calculated the risks of radiation and presented the ethical and legal framework. The subject was scrutinised by an interdisciplinary panel.


RESULTS
Irradiation is the most effective means for prophylaxis and has few adverse effects in adult patients with fractures of the acetabulum. The lifetime risk of radiation-induced cancer or infertility are insignificant.


CONCLUSIONS
Informed consent for irradiation should be obtained before operation whenever possible. When this cannot be done prophylaxis can be postponed for a maximum of 3 days in order to obtain consent. If the patient is not able to communicate within this period, prophylactic irradiation should be given after consulting the relatives. The patient must be informed as soon as possible.
Oertel
Susanne
S
Department of Radiooncology, Zurich University Hospital, Zurich, Switzerland. Susanne_oertel@med.uni-heidelberg.de
Schneider
Uwe
U
Keel
Marius
M
Lütolf
Urs Martin
UM
Bosshard
Georg
G
D000077:Acetabulum / Q000293:injuries*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D050723:Fractures, Bone / Q000150:complications / Q000532:radiotherapy; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D009999:Ossification, Heterotopic / Q000453:epidemiology* / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects*; D018570:Risk Assessment