This 2015 JBJS Current Concepts Review synthesizes the epidemiology, pathophysiology, classification, and management of heterotopic ossification across all major clinical contexts. It answers the question: who gets it, why does it form, and what do we do about it? The paper spans burn injury, neurologic injury, arthroplasty, and fracture care.
Heterotopic ossification is easy to miss early and hard to treat once established. The key clinical skill this paper reinforces is anticipating who is at risk before the HO forms.
When you are fixing an acetabular fracture, the approach matters: the anterior approach carries the highest HO rate (42.1%) compared to the trochanteric flip (33.3%). If you use indomethacin for prophylaxis, counsel the patient and your team that nonunion risk rises — radiation may be a better choice here.
For burn patients, burns covering more than 20% of total body surface area substantially raise HO risk. At the elbow specifically, a palpable locking sensation at end-range motion points toward HO rather than contracture, which changes how you image and plan intervention.
Timing of surgical excision is not arbitrary: waiting 18 months after traumatic brain injury before resecting is the standard, and rushing to the OR earlier after neurologic injury leads to higher recurrence and complication rates.
This 2015 JBJS Current Concepts Review synthesizes the epidemiology, pathophysiology, classification, and management of heterotopic ossification across all major clinical contexts. It answers the question: who gets it, why does it form, and what do we do about it? The paper spans burn injury, neurologic injury, arthroplasty, and fracture care.
Heterotopic ossification is easy to miss early and hard to treat once established. The key clinical skill this paper reinforces is anticipating who is at risk before the HO forms.
When you are fixing an acetabular fracture, the approach matters: the anterior approach carries the highest HO rate (42.1%) compared to the trochanteric flip (33.3%). If you use indomethacin for prophylaxis, counsel the patient and your team that nonunion risk rises — radiation may be a better choice here.
For burn patients, burns covering more than 20% of total body surface area substantially raise HO risk. At the elbow specifically, a palpable locking sensation at end-range motion points toward HO rather than contracture, which changes how you image and plan intervention.
Timing of surgical excision is not arbitrary: waiting 18 months after traumatic brain injury before resecting is the standard, and rushing to the OR earlier after neurologic injury leads to higher recurrence and complication rates.