title: Risk of symptomatic heterotopic ossification following plate osteosynthesis in multiple trauma patients: an analysis in a level-1 trauma centre.
abstract: BACKGROUND
  Symptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the effect of surgical treatment on formation of symptomatic heterotopic ossification in polytrauma is sparse. Therefore, we test the effects of surgical treatment (plate osteosynthesis or intramedullary nailing) on the formation of heterotopic ossification in the multiple trauma patient.
  
  
  METHODS
  We retrospectively analysed prospectively documented data of blunt multiple trauma patients with long bone fractures which were treated at our level-1 trauma centre between 1997 and 2005. Patients were distributed to 2 groups: Patients treated by intramedullary nails (group IMN) or plate osteosynthesis (group PLATE) were compared. The expression and extension of symptomatic heterotopic ossifications on 3-6 months follow-up x-rays in antero-posterior (ap) and lateral views were classified radiologically and the maximum expansion was measured in millimeter (mm). Additionally, ventilation time, prophylactic medication like indomethacine and incidence and correlation of head injuries were analysed.
  
  
  RESULTS
  101 patients were included in our study, 79 men and 22 women. The fractures were treated by intramedullary nails (group IMN n = 50) or plate osteosynthesis (group PLATE n = 51). Significantly higher radiologic ossification classes were detected in group PLATE (2.9 +/- 1.3) as compared to IMN (2.2 +/- 1.1; p = 0.013). HO size in mm ap and lateral showed a tendency towards larger HOs in the PLATE group. Additionally PLATE group showed a higher rate of articular fractures (63% vs. 28% in IMN) while IMN demonstrated a higher rate of diaphyseal fractures (72% vs. 37% in PLATE; p = 0.003). Ventilation time, indomethacine and incidence of head injuries showed no significant difference between groups.
  
  
  CONCLUSIONS
  Fracture care with plate osteosynthesis in polytrauma patients is associated with larger formations of symptomatic heterotopic ossifications (HO) while intramedullary nailing was associated with a higher rate of remote HO. For future fracture care of multiply injured patients these facts may be considered by the responsible surgeon.
authors.affiliation: Trauma Department, Hannover Medical School, Hannover, Germany. Zeckey.christian@mh-hannover.de
authors.forename: Christian
authors.initials: C
authors.lastname: Zeckey
authors.forename: Frank
authors.initials: F
authors.lastname: Hildebrand
authors.forename: Philipp
authors.initials: P
authors.lastname: Mommsen
authors.forename: Julia
authors.initials: J
authors.lastname: Schumann
authors.forename: Michael
authors.initials: M
authors.lastname: Frink
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D009999:Ossification, Heterotopic / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers / Q000145:classification*; D055815:Young Adult