Heterotopic ossifications and severe burns: epidemiology and risk factors
Dr Gratiane DE BRIERa, Dr Laurent THEFENNEa, Dr Claire JOURDANb, Dr Jean Francois LANNOYc, Dr Claire NICOLASd, Dr Thomas LECLERCe, Prof François GENETb
a HIA Laveran, service MPR, b CHU Raymond Poincare, c CRF La Musse, d CRF Coubert, e HIA Percy
Objectives: Life after a burn is conditioned by the sequelae that can persist. Heterotopic ossifications may result in limitations of range of motion and functional impairment. Physiopathology and risk factors are still poorly understood. The purpose was to study the epidemiology of patients managed in burn care center, and to study the potential role of length of stay in burn care center, cutaneous, pulmonary and urinary infections, total and deep body burnt area, use of curare and use of air fluidized bed and their duration of use on the development of heterotopic ossifications.
Methods: It is a case control study. We studied the medical records of patients managed in Percy hospital burn care center, from January 1st, 2009 to December 31st, 2013, and then sent in the rehabilitation centers La Musse and Coubert or in Percy hospital.
Results: Eight hundred and five patients were included. Thirty-two patients (4%) developed 74 heterotopic ossifications. Heterotopic ossifications were mainly localized around elbows, then around hips, shoulders and knees. Each patient was associated with 3 controls. We found a significant association between length of stay in burn care center, total and deep burnt surfaces, pulmonary or cutaneous infection, utilisation of curare and utilisation of air fluidized bed and its duration of use, and heterotopic ossification development.
Discussion : The epidemiology of our population and of heterotopic ossification is similar to that found in the literature. We confirmed the suspected risk factors. We identified two new elements: utilisation of curare and of air fluidized bed; the association was significant. The role of these two elements is not clear; we need specific studies to understand. We also need superior level of evidence studies to confirm our results.
Keywords : heterotopic ossification – burns – risk factors