Heterotopic Ossifications after Fractures of the Anterior Pelvic Segment: Overview of Morphology and Clinical Correlations

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00064173%3A_____%2F21%3A43922041" target="_blank" >RIV/00064173:_____/21:43922041 - isvavai.cz</a>

Alternative codes found

RIV/00216208:11120/21:43922041

Result on the web

<a href="http://www.achot.cz/detail.php?stat=1212" target="_blank" >http://www.achot.cz/detail.php?stat=1212</a>

DOI - Digital Object Identifier

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Result language

angličtina

Original language name

Heterotopic Ossifications after Fractures of the Anterior Pelvic Segment: Overview of Morphology and Clinical Correlations

Original language description

PURPOSE OF THE STUDY In certain patients after treated pelvic fractures, heterotopic ossifications can be observed in the area of the pubic bone, which protrude ventrally, and often also laterally and distally into surrounding soft tissues of the groin or even medially into the proximal thigh. These ossifications are shaped like sharp spikes of various lengths, which is why the authors refer to them as &quot;spicules&quot;. In some patients, these ossifications are also associated with pain. The aim of this study was to provide an overview of the morphology of heterotopic ossifications of the anterior segment of the pelvis and to discuss the etiology of their origin, and further to determine the incidence, risk factors and clinical significance of these &quot;spike-like&quot; ossifications. MATERIAL AND METHODS X-ray images of patients treated for pelvic injuries between 2009 and 2018, in whom radiological documentation was available at least 12 months after the injury or surgery were evaluated. Patients with acetabular fractures or combined pelvic and acetabular injuries were not included in the study. Possible risk factors studied included gender, severity of injury, type of fracture according to the AO / ASIF classification, concomitant bladder injury, method of treatment and type of osteosynthesis of the anterior segment of the pelvis. The categorial data concerning risk factors for the observed &quot;spicule&quot; type ossifications was statistically evaluated using the chi-square test at the 5% level of significance. RESULTS The studied group consisted of 218 patients (121 women, 97 men) aged 13 to 92 years of age (mean age was 54 years, median age was 55 years). Heterotopic &quot;spicule&quot; type ossifications occurred in 21 patients (4 females, 17 males) aged 18 to 76 years (mean 39 years, median 41 years). Significant risk factors in the observed ossification group included male sex (p = 0.0004), severity of trauma (predominance of &quot;spicules&quot; was seen in multiple trauma patients, (p = 0.0024), unstable pelvic injury according to AO / ASIF classification (predominance of &quot;spicules&quot; in type B and C fractures over type A fractures, (p = 0.0013), concomitant bladder injury (p = 0.0009) and in patients undergoing surgical treatment of the fracture (p &lt; 0.0001), where all the observed spicules were seen in patients undergoing anterior pelvic segment osteosynthesis. A statistically significant difference was also evident when comparing the osteosynthetic material used in the anterior segment (a increased incidence of ossifications was seen in patients undergoing plate fixation compared to patients in whom pubic screws were used, p = 0.0050). DISCUSSION Heterotopic ossifications are described as relatively common consequences of pelvic fractures, but are not considered a major problem because they usually do not produce any clinical correlations. The causes of post-traumatic and postoperative ossifications in the pelvic area include the effects of high energy traumas, extensive surgical procedures, prolonged artificial lung ventilation, and post-infectious states after complications of surgical treatment. CONCLUSIONS The study identified risk factors for heterotopic &quot;spicule&quot; type ossifications. The identified risk factors include male sex, severity of injury, unstable type of fracture, concomitant bladder injury, surgical treatment, and the use of massive implants. Only the effect of bladder injuries can be partially influenced by performing less invasive surgical techniques during combined pelvic and bladder injuries.

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

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OECD FORD branch

30211 - Orthopaedics

Project

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Continuities

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2021

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

Acta Chirurgiae Orthopaedicae et Traumatologiae Čechoslovaca

ISSN

0001-5415

e-ISSN

2570-981X

Volume of the periodical

88

Issue of the periodical within the volume

4

Country of publishing house

CZ - CZECH REPUBLIC

Number of pages

7

Pages from-to

253-259

UT code for WoS article

000811383200001

EID of the result in the Scopus database

2-s2.0-85116875164