Standardized protocol during acetabular fracture surgery results in low rates of heterotopic ossification

To assess the rate of heterotopic ossification (HO) following acetabular surgery with a standardized protocol via the Kocher-Langenbeck. Secondarily, to evaluate patient characteristics, injury variables, and perioperative data among patients with HO and no HO.

This was a retrospective case series from an academic Level I trauma center. Included patients had displaced acetabular fractures treated via Kocher-Langenbeck approach with debridement of (1) gluteus minimus muscle (GMM) from the posterior wall and column up to the superior gluteal neurovascular bundle, (2) unhealthy appearing piriformis muscle without fascial disruption, and (3) superior and inferior gemelli in the location of implant placement. Those with posterior hip dislocations and gluteus medius injury received prophylactic indomethacin.

Fifty-seven patients met inclusion criteria. Thirteen patients (22.8%) developed HO, and 44 patients (77.2%) had no evidence of HO. Ten (17%) patients developed mild HO (Brooker classification (BC) I/II), 3 (5%) developed moderate HO (BC III), and no patients developed severe HO (BC IV). There were no differences in the prevalence of elementary versus associated acetabular fracture patterns or individual fracture patterns among cohorts. Patients with HO had longer times to surgical intervention (5.3 ± 5.1 days vs. 2.4 ± 1.6 days, p = 0.002) and length of intensive care unit (ICU) stay (6.7 ± 12.2 days vs. 1.5 ± 3.3 days, p = 0.013) compared with the no HO cohort. There was no difference in rates of HO prophylaxis use and subsequent HO among cohorts.

This study describes a standardized protocol developed by the senior author that resulted in low rates of HO following acetabular fixation via the Kocher-Langenbeck approach. Patients with HO had a significantly longer time to surgical intervention and length of ICU level of care.

Therapeutic Level IV. See Instructions for Authors of a complete description of levels of evidence.