title: Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: five case histories and results from a small series of patients.
abstract: Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.
authors.affiliation: Medical Modeling, Simulation and Mission Support Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106, USA. ted.melcer@med.navy.mil
authors.forename: Ted
authors.initials: T
authors.lastname: Melcer
authors.forename: Brian
authors.initials: B
authors.lastname: Belnap
authors.forename: G Jay
authors.initials: GJ
authors.lastname: Walker
authors.forename: Paula
authors.initials: P
authors.lastname: Konoske
authors.forename: Michael
authors.initials: M
authors.lastname: Galarneau
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000009:adverse effects*; D000672:Amputation Stumps / Q000000981:diagnostic imaging*; D000674:Amputees / Q000534:rehabilitation; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D009999:Ossification, Heterotopic / Q000000981:diagnostic imaging / Q000209:etiology*; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D014857:Warfare; D055815:Young Adult