The development and impact of heterotopic ossification in burns: a review of four decades of research

Abstract

Introduction: Heterotopic ossification (HO) is the formation of lamellar bone within connective and other tissue where bone should not form and is a rare complication after burn injury. However, it leads to severe pain and distress, marked reduction in joint range of motion (ROM), impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of HO remain poorly understood in burns and other traumas and the management, controversial. The aim of this comprehensive review, therefore, was to synthesise the available evidence on the development and treatment of HO after acute burn injury.

Methods: The review was based on a systematic search of five electronic databases PubMed, EMBASE, CINAHL, LILACS and Scopus.

Results: Synthesis and analysis of the data highlighted that, despite the passage of time, little translatable evidence is available to guide any prevention, screening, diagnostic or pharmacological or physical management protocols.

Discussion: Causes of HO remain confounded, therefore prevention is difficult. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when ROM and activities of daily living are severely affected.

Conclusion: The findings from this review indicate that multicentre data pooling is needed to understand the optimum pathway to prevention, identification and treatment of HO in acute burn patients.

Keywords: Activities of daily living; HO; bisphosphonate; burns; elbow; etidronate disodium; heterotopic ossification; range of motion; review; surgical resection; trauma; ulnar nerve entrapment.

Figure 1.

Decision trail of included studies.