A retrospective review of the management and functional outcomes of patients who developed Heterotopic Ossification in one or bilateral upper limbs post severe burn injury at Royal Brisbane and Women’s Hospital (RBWH) between 2006 and 2016

Miss Andrea Mc Kittrick1, Mrs Amber Jones1, Dr Jason Brown2

1Department of Occupational Therapy, Royal Brisbane and Women’s Hospital, Herston, Australia, 2.  Professor Stuart Pegg Adult Burns Centre, Royal Brisbane and Women’s Hospital, Herston, Australia



Heterotopic ossification (HO) is defined as the presence of calcium bone deposits in soft tissue and connective tissue where bone is not normally found. It is found in patients who have sustained trauma including spinal, brain and severe burn injuries and it can be classified as a complication of trauma injuries. The aims of this study were:

  • To review the surgical and occupational therapy (OT) management of all patients presenting to RBWH for a 10-year period who sustained a severe burn injury greater than 30% TBSA to the upper extremities
  • To review the long-term management plan for patients who developed HO


This study was a retrospective review. Ethics: LNR/2018/QRBW/45689



n= 20 for inclusion. Mean TBSA = 59.5%. Bilateral upper limb involvement n= 20. Average surgical procedures per patient =3. Biobrane® and allograft were the most frequent temporising procedures with sandwich grafting preferred for definitive surgery. OT interventions commenced day 2 (range 1-4) post admission. Elbow splints were in situ 24/24 average 14.8 days. Occupational therapy interventions involved provision of adaptive ADL equipment, ADL retraining and upper limb group therapy. Chronic pain team were involved in all cases: Indomethcain and Entonox most often prescribed for joint pain and stiffness. >10% underwent surgery for removal of HO.


The presence of HO can result in increased pain, decreased range of motion and a decrease in participation in activities of daily living.


Our study found that early surgical intervention, strong links with pain services and an intensive rehabilitation programme promotes long term return to ADL’s, work and driving post development of HO which is in line with current evidence based literature.


Andrea is the Advanced Specialist Occupational Therapist in Severe Burn Injuries at the Royal Brisbane and Women’s Hospital in Brisbane, Queensland. She graduated from Trinity College Dublin, Ireland in 2004.  She a Masters in Hand Therapy via University of Derby, United Kingdom in 2015. Andrea is currently enrolled in a PhD through The University of Queensland. She is the current chair of the ANZBA Allied Health committee, and is a casual academic at The University of Queensland and a session lecturer at Australian Catholic University.  Her special interests include hand burn injuries, critical care polyneuropathy and long term outcomes post burn injury.


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