Journal of Rehabilitation Research & Development (JRRD)

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JRRD PowerPoint Slide Set

Volume 48 Number 1, 2011
   Pages 1 — 12

Abstract —  Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients

Ted Melcer, PhD;1* Brian Belnap, DO;2 G . Jay Walker, BA;3 Paula Konoske, PhD;1 Michael Galarneau, MS1

1Medical Modeling, Simulation and Mission Support Department, Naval Health Research Center, San Diego, CA; 2Comprehensive Complex and Casualty Care Center, Naval Medical Center San Diego, San Diego, CA; 3Science Applications International Corporation, McLean, VA

Abstract — Heterotopic ossification (HO) is excess bone growth in soft tissues that frequently occurs in the residual limbs of combat amputees injured in Operation Iraqi Freedom and Operation Enduring Freedom, or Iraq and Afghanistan wars, respectively. HO can interfere with prosthetic use and walking and delay patient rehabilitation. This article describes symptomatic and/or radiographic evidence of HO in a patient series of combat amputees rehabilitating at a military amputee care clinic (27 patients/33 limbs). We conducted a retrospective review of patient records and physician interviews to document evidence of HO symptoms in these limbs (e.g., pain during prosthetic use, skin breakdown). Results showed HO-related symptoms in 10 of the 33 residual limbs. Radiographs were available for 25 of the 33 limbs, and a physician identified at least moderate HO in 15 of the radiographs. However, 5 of the 15 patients who showed at least moderate radiographic HO did not report adverse symptoms. Five individual patient histories described HO onset, symptoms, treatments, and outcomes. These case histories illustrated how HO location relative to pressure-sensitive/pressure-tolerant areas of the residual limb may determine whether patients experienced symptoms. These histories revealed the uncommon but novel finding of potential benefits of HO for prosthetic suspension.

Key words: Afghanistan war, amputation, blast injury, combat amputee, heterotopic ossification, Iraq war, physical medicine, prosthesis, radiograph, rehabilitation.

This article and any supplementary material should be cited as follows:
Melcer T, Belnap B, Walker GJ, Konoske P, Galarneau M. Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients. J Rehabil Res Dev. 2011; 48(1):1-12.
DOI:10.1682/JRRD.2010.03.0033
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Last Reviewed or Updated  Thursday, March 31, 2011 8:55 AM

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