SciELO - Scientific Electronic Library Online

 
vol.8 issue2Tribute to Gordon Mthuthuzeli SibotoPosterior fracture dislocation of the hip joint in motor vehicle occupants author indexsubject indexarticles search
Home Pagealphabetic serial listing  

SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

SA orthop. j. vol.8 n.2 Pretoria Jan. 2009

 

CLINICAL ARTICLE

 

Indomethacin and heterotopic ossification in acetabular fractures: A prospective cohort study of the effect indomethacin has on the incidence and severity of heterotopic ossification

 

 

GM SibotoI; SJL RocheI; J WaltersII

IFC(Orthop)SA, Orthopaedic surgeon; Groote Schuur Hospital, Department of Orthopaedics, University of Cape Town, Cape Town, Republic of South Africa
IIFC(Orthop)SA, Professor and Head of Orthopaedics; Groote Schuur Hospital, Department of Orthopaedics, University of Cape Town, Cape Town, Republic of South Africa

Correspondence

 

 


ABSTRACT

Heterotopic ossification (HO) that complicates acetabular fractures is initiated at the time of injury.19 We hypothesised that indomethacin medication commenced prior to surgery and within the first week following injury would be more effective than post-operative use alone. Over a four-year period 184 consecutive patients with significantly displaced acetabular fractures scheduled for acetabular reconstructive surgery were included in the study.
Fifty-seven patients received indomethacin post-operatively only (Group 1), 95 pre- and post-operatively (Group 2), and 19 received no treatment for various reasons including intolerance of NSAIDs(Group 3). Three patients died and ten were lost to follow-up.
Standard AP radiographs were reviewed at 2 weeks, 6 weeks, 3 months, 6 months and 12 months post-op and were grading as per Brooker on the 3-month follow-up radiograph.
The mean Brooker values for Group 1 = 0.70; Group 2 = 0.33; Group 3 = 1.57. A statistical analysis of the p-values for Group 1 compared to Group 2 = 0.04; Group 1 to Group 3 = 0.002; Group 2 to Group 3 = 0.000006.
Associated injury was the only parameter that correlated with increasing heterotopic ossification, while age, sex, approach and fracture type had no influence.
This study confirms that indomethacin reduces the incidence and severity of HO in acetabular fracture surgery and is more effective if started pre-operatively.


 

 

“Full text available only in PDF format”

 

 

References

1. Ahrengart L, Lindgren U, Reinholt FP. Comparative study of the effects of radiation, indomethacin, prednisolone, and ethane-1-hydroxy-1,1-diphosphonate in the prevention of ectopic bone formation. Clin Orthop 1988;229;265-73.         [ Links ]

2. Bosse MJ, Poka A, Reinert CM, Ellwanger F, Slawson R, McDevitt ER. Heterotopic ossification as a complication of acetabular fracture: prophylaxis with low-dose irradiation. J Bone Joint Surg [Am] 1988; 70-A:1231-7.

3. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement: incidence and method of classification. J Bone Joint Surg [Am] 1973;55-A: 1629-32.

4. Chalmers J, Gray DH, Rush J. Observation on the induction of bone in soft tissues. J Bone Joint Surg [Br] 1975;57-B:36-45.

5. Ghalambor N, Matta JM, Bernstein L. Heterotopic ossification following operative treatment of acetabular fracture. Clin Orthop;305:96-105.         [ Links ]

6. Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop 1994;305:88-95.         [ Links ]

7. Kjaersgaard-Andersen P, Ritter MA. Prevention of heterotopic ossification after total hip arthroplasty. J Bone Joint Surg [Am] 1991; 72A:942.

8. Knelles D, Barthel T, Karrer A, Kraus U, Eulert J, Kolbl O. Prevention of heterotopic ossification after total hip replacement; a prospective, randomised study using acetylsalicylic acid, indomethacin and fractional or single-dose irradiation. J Bone Joint Surg [Br] 1997;79-B:596-601.         [ Links ]

9. Letournel E, Judet R. Fractures of the Acetabulum. 2nd edition. New York: Springer-Verlag. 1993;588.         [ Links ]

10. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum: a retrospective analysis. Clin Orthop 1986;205:230-40.         [ Links ]

11. Matta JM, Mehne DK, Roffi R. Fractures of the acetabulum: early results of a prospective study. Clin Orthop1986;205:241-50.         [ Links ]

12. Matta JM, Siebenrock KA. Does indomethacin reduce heterotopic bone formation after operations for acetabular fractures: a prospective randomised study. J Bone Joint Surg [Br] 1997;79-B:959-63.         [ Links ]

13. McLaren AC. Prophylaxis with indomethacin for heterotopic bone. J Bone Joint Surgery [Am] 1990;72-A:245-7.         [ Links ]

14. Moed BR, Karges DE. Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients. J Orthop Trauma 1994;8:34-9.         [ Links ]

15. Moed BR, Letournel E. Low-dose irradiation and indomethacin prevent heterotopic ossification after acetabular surgery. J Bone Joint Surg [Br] 1994;76-B:895-900.         [ Links ]

16. Moore KD, Goss K, Anglen JO. Indomethacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures. J Bone Joint Surg [Br] 1998;80-B:259-63.         [ Links ]

17. Pantazopoulos T, Mousafiris C. Surgical treatment of central acetabular fractures. Clin Orthop 1989;246:57-64.         [ Links ]

18. Pelligrini VD, Gregoritch SJ. Preoperative irradiation for prevention of heterotopic ossification following total hip arthroplasty. J Bone Joint Surg [Am] 1996;78-A:870-81.         [ Links ]

19. Pennal GF, Davidson J, Garside H, Plewes J. Results of treatment of acetabular fractures. Clin Orthop 1980;151:115-23.         [ Links ]

20. Ritter M, Sieber JM. Prophylactic indomethacin for the prevention of heterotopic bone formation following total hip arthroplasty. Clin Orthop1985; 196:217-25.         [ Links ]

21. Sawyer JR, Myers MA, Rosier RN, Puzas JE. Heterotopic ossification: clinical and cellular aspects. Calcif Tissue Int 1991;49:208-15.         [ Links ]

22. Schmidt ST, Kjaersgaard-Anderson P, Pedersen NW, Kristensen SS, Pedersen P, Nielsen JB. The use of indomethacin to prevent the formation of heterotopic bone after total hip replacement: a randomised, double-blinded clinical trial. J Bone Joint Surg [Am] 1988;70-A:834-8.         [ Links ]

23. Slawson RG, Poka A, Bathon H, Salazar OM, Bromback RJ, Burgess AR. The role of post-operative radiation in the prevention of heterotopic ossification in patients with post-traumatic acetabular fracture. Int J Radiation Oncology Biol Phys 1989;17:669-72.         [ Links ]

24. Tonna EA, Cronkite EP. Autoradiographic studies of cell proliferation in the periosteum of intact and fractured femora of mice utilizing DNA labelling with H3- thymidine. Proc Soc Exper Biol and Med 1961;107:719-21.         [ Links ]

25. Tornkvist H, Bauer FCH, Nilsson O. Influence of indomethacin on experimental bone metabolism in rats. Clin Orthop1985;193:264-70.         [ Links ]

 

 

Correspondence:
S Roche
4 Selwyn Rd
Kenilworth, Cape Town
South Africa
Tel/fax: +27 21 762-4294
Email: sroche@iafrica.com

 

 

The content of this article and the preparation of this article is the sole work of the authors. In the absence of GS, HSR and JW are prepared to discuss the article in detail. No financial assistance was or will be received for the preparation of this paper and no benefit will be derived from any commercial party.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License