A review of heterotopic ossification in burns: Implications for treatment and research.

Dr  Rachel Kornhaber1,8, Miss Nichola  Foster3, Associate Professor  Dale  Edgar4,5,6, Dr Denis  Visentin1, Dr  Elad  Ofir7,8, Professor  Josef Haik7,8,9, Dr Moti Harats7,8

1University of Tasmania, Rozelle, Australia, 2Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel, 3Sir Charles Gairdner Hospital, Nedlands, Australia, 4Burn Injury Research Node, The University of Notre Dame , Fremantle, Australia, 5State Adult Burn Unit, Fiona Stanley Hospital, Murdoch , Australia, 6Fiona Wood Foundation, Murdoch, Australia, 7Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 8Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel, 9Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer,, Israel

A review of heterotopic ossification in burns: Implications for treatment and research

Heterotopic ossification is the anomalous formation of lamellar bone within connective and soft tissues. Heterotopic ossification is a rare complication after a burn injury and leads to severe pain and distress, marked reduction in joint range of motion, impaired function and increased hospital length of stay. The pathophysiology, incidence and risk factors of heterotopic ossification are poorly understood within the domain of burns and other traumas and the management remains controversial. Therefore, the aim of this comprehensive review was to synthesise the available evidence on the development and treatment of heterotopic ossification after sustaining an acute burn injury. The review was based on a systematic search of electronic databases. Synthesis and analysis of the data highlighted that, despite the passage of time, there was a lack of quality, translatable evidence available to guide any prevention, screening, diagnosis, and pharmacological or physical management protocols. Causes of heterotopic ossification remain confounded and anecdotal; prevention of heterotopic ossification remains elusive. Although spontaneous resolution is possible, surgical resection remains the recommended treatment when range of motion and activities of daily living are severely affected, despite the significant, long duration of preoperative morbidity and complication rate of surgical resection. This review indicates that multicentre data pooling is required to amass an adequate sized sample of heterotopic ossification patients to analyse and explore the optimum pathway to prevention, identification and treatment of heterotopic ossification in acute burns.

A senior physiotherapist and researcher for over 20 years, the past 17 have been devoted to the specialisation in provision and improvement of burn survivor and acute trauma rehabilitation in a number of Australian burns and plastic surgery units. Dale has first class honours degree in physiotherapy and a PhD.

Dale lectures for the Schools of Physiotherapy at Curtin University of Technology (WA); University of Notre Dame (Fremantle, WA); and, James Cook University (QLD) and has a clinical lecturer appointment to the School of Surgery, University of Western Australia. He supervises and mentors medical, public health and physiotherapy undergraduate and postgraduate students in research. Dale is the Chair of the International Society for Burn Injury (ISBI) Rehabilitation Committee, Chair of the Allied Health Group Australian & New Zealand Burns Association (ANZBA), a Member of the Joanna Briggs Institute (JBI) Burns Node Expert Reference Group and Senior Physiotherapist, Royal Perth Hospital, Burn Service WA.

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