Prevalence of Traumatic Heterotopic Ossification and its impact on length of stay in West Australian tertiary Hospitals

Miss Nichola Foster1, Associate Professor Dale Edgar1,2,3, Winthrop Professor Fiona Wood2,3, Dr Edward Raby2,3, Dr  Mark Fear2, Associate Professor Nathan Pavlos4

1Burn Injury Research Node, Institute for Health Research / School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia, 2Burn Injury Research Unit, University of Western Australia, Crawley, Australia, 3State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia, 4School of Biomedical Sciences, University of Western Australia, Nedlands, Australia



Heterotopic ossification (HO) is the abnormal formation of bone outside the normal skeleton, including soft tissues and joints. HO presents a substantial barrier to rehabilitation for burn and trauma injured patients.  There is no known comparative epidemiological studies exploring data from pooled traumatic HO populations.


To define the prevalence of traumatic HO in patients admitted to tertiary hospitals in WA and, to determine length of stay (LOS).


A retrospective audit of trauma patients over an 11 year period was carried out at 4 major WA tertiary hospitals in April 2020. The outcome of interest in burns, neurological and orthopaedic trauma was the presence of HO. Clinical and demographic data relating to age, gender and LOS were recorded. Continuous and nominal variables were compared between subjects with HO and without HO using tests appropriate to the shape of the data.


A total of 93 patients were diagnosed with traumatic HO for all sites and diagnoses, 23.1% burns, 41% neurological and 35.7% orthopaedic. The elbow was more involved in burns (72.7%) than neurological (12.8%) and orthopaedic (14.7%) patients. Hip joint involvement was evident in 89.% of neurological cases and only a single (4.5%) burns case. The mean LOS(days) for the neurological (159.6±79.5) and burn (119.9±65.4) HO cohort was significantly higher than for orthopaedics (26.6±37.6).


The location of HO seems to differ with mode of trauma which may guide investigation into underlying mechanism. Investigation into factors associated with differences in LOS between HO cohorts is ongoing.


Nichola is a neurological physiotherapist and her main areas of clinical interest involve the acute and rehabilitation management of patients with stroke, traumatic brain injury, spinal cord injury and other neurodegenerative conditions. She is undertaking a PhD through the School of Physiotherapy at The University of Notre Dame, Australia. Her research is investigating the prevalence, risk factors, prevention and treatment of traumatic heterotopic ossification after burn, neurological and orthopaedic trauma.

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