The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes

The PREP-IT Investigators; Executive Committee; Steering Committee; Adjudication Committee; Data and Safety Monitoring Committee; Research Methodology Core; Patient Centred Outcomes Core; Orthopaedic Surgery Core; Operating Room Core; Infectious Disease Core; Military Core; McMaster University Methods Center (Hamilton, ON); University of Maryland School of Medicine Administrative Center (Baltimore, MD); University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD); PREP-IT Clinical Sites; Lead Clinical Site (Aqueous-PREP and PREPARE); University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD; Aqueous-PREP and PREPARE; Hamilton Health Sciences – General Site, Hamilton, ON; Prisma Health - Upstate, Greenville, SC; IU Health Methodist Hospital, Indianapolis, IN; San Antonio Military Medical Center, San Antonio, TX; University of California, San Francisco, San Francisco, CA; Aqueous-PREP; Vanderbilt Medical Center, Nashville, TN; University of Florida, Gainesville, FL; McGovern Medical School at UTHealth Houston, Houston, TX; Wright State University, Dayton, OH; Banner University Medical Center – Tucson, Tucson, AZ; The CORE Institute, Phoenix, AZ; Vall d'Hebron University Hospital, Barcelona, Spain; Hospital Universitari Parc Tauli, Barcelona, Spain; PREPARE; FRASER HEALTH AUTHORITY/Royal Columbian Hospital, New Westminster, BC; Inova Fairfax Medical Campus, Falls Church, VA; Wake Forest Baptist Health, Winston-Salem, NC; MetroHealth Medical Center, Cleveland, OH; University of Utah, Salt Lake City, Utah; University of Mississippi Medical Center, Jackson, MS; Sanford Health, Sioux Falls, SD; Dartmouth-Hitchcock Medical Center, Lebanon, NH; Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC; University of Maryland, Capital Region Health, Largo, MD; University of Wisconsin Madison, Madison, WI; Duke University Hospital, Durham, NC; Brigham Women's Hospital, Boston, MA; University of Pennsylvania, Philadelphia, PA; Massachusetts General Hospital, Boston, MA; Bryan Medical Center, Lincoln, Nebraska; University of Cincinnati, Cincinnati, OH; Cedars-Sinai Medical Center, Los Angeles, CA; University of California, Irvine, Orange, CA

doi:10.1016/j.injury.2023.03.001

The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes

The PREP-IT Investigators, Executive Committee, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core, Patient Centred Outcomes Core, Orthopaedic Surgery Core, Operating Room Core, Infectious Disease Core, Military Core, McMaster University Methods Center (Hamilton, ON), University of Maryland School of Medicine Administrative Center (Baltimore, MD), University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD), PREP-IT Clinical Sites, Lead Clinical Site (Aqueous-PREP and PREPARE), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD, Aqueous-PREP and PREPARE, Hamilton Health Sciences – General Site, Hamilton, ON, Prisma Health - Upstate, Greenville, SCIU Health Methodist Hospital, Indianapolis, IN, San Antonio Military Medical Center, San Antonio, TX, University of California, San Francisco, San Francisco, CA, Aqueous-PREP, Vanderbilt Medical Center, Nashville, TN, University of Florida, Gainesville, FL, McGovern Medical School at UTHealth Houston, Houston, TX, Wright State University, Dayton, OH, Banner University Medical Center – Tucson, Tucson, AZ, The CORE Institute, Phoenix, AZ, Vall d'Hebron University Hospital, Barcelona, Spain, Hospital Universitari Parc Tauli, Barcelona, Spain, PREPARE, FRASER HEALTH AUTHORITY/Royal Columbian Hospital, New Westminster, BC, Inova Fairfax Medical Campus, Falls Church, VA, Wake Forest Baptist Health, Winston-Salem, NC, MetroHealth Medical Center, Cleveland, OH, University of Utah, Salt Lake City, Utah, University of Mississippi Medical Center, Jackson, MS, Sanford Health, Sioux Falls, SD, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, University of Maryland, Capital Region Health, Largo, MD, University of Wisconsin Madison, Madison, WI, Duke University Hospital, Durham, NC, Brigham Women's Hospital, Boston, MA, University of Pennsylvania, Philadelphia, PA, Massachusetts General Hospital, Boston, MA, Bryan Medical Center, Lincoln, Nebraska, University of Cincinnati, Cincinnati, OH, Cedars-Sinai Medical Center, Los Angeles, CA, University of California, Irvine, Orange, CA

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. Methods: We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results: 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). Conclusion: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.

Original language	English
Pages (from-to)	1693-1701
Number of pages	9
Journal	Injury
Volume	54
Issue number	6
DOIs	https://doi.org/10.1016/j.injury.2023.03.001
State	Published - Jun 2023

Keywords

Acetabular fractures
Heterotopic ossification
Indomethacin prophylaxis
XRT prophylaxis

Access to Document

10.1016/j.injury.2023.03.001

Cite this

The PREP-IT Investigators, Executive Committee, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core, Patient Centred Outcomes Core, Orthopaedic Surgery Core, Operating Room Core, Infectious Disease Core, Military Core, McMaster University Methods Center (Hamilton, ON), University of Maryland School of Medicine Administrative Center (Baltimore, MD), University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD), PREP-IT Clinical Sites, Lead Clinical Site (Aqueous-PREP and PREPARE), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD, Aqueous-PREP and PREPARE, Hamilton Health Sciences – General Site, Hamilton, ON, ... University of California, Irvine, Orange, CA (2023). The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes. Injury, 54(6), 1693-1701. https://doi.org/10.1016/j.injury.2023.03.001

@article{03014d73287443599c71f2f3084e2f33,

title = "The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes",

abstract = "Background: Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. Methods: We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results: 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). Conclusion: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.",

keywords = "Acetabular fractures, Heterotopic ossification, Indomethacin prophylaxis, XRT prophylaxis",

author = "{The PREP-IT Investigators} and {Executive Committee} and {Steering Committee} and {Adjudication Committee} and {Data and Safety Monitoring Committee} and {Research Methodology Core} and {Patient Centred Outcomes Core} and {Orthopaedic Surgery Core} and {Operating Room Core} and {Infectious Disease Core} and {Military Core} and {McMaster University Methods Center (Hamilton, ON)} and {University of Maryland School of Medicine Administrative Center (Baltimore, MD)} and {University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD)} and {PREP-IT Clinical Sites} and {Lead Clinical Site (Aqueous-PREP and PREPARE)} and {University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD} and {Aqueous-PREP and PREPARE} and {Hamilton Health Sciences – General Site, Hamilton, ON} and {Prisma Health - Upstate, Greenville, SC} and {IU Health Methodist Hospital, Indianapolis, IN} and {San Antonio Military Medical Center, San Antonio, TX} and {University of California, San Francisco, San Francisco, CA} and Aqueous-PREP and {Vanderbilt Medical Center, Nashville, TN} and {University of Florida, Gainesville, FL} and {McGovern Medical School at UTHealth Houston, Houston, TX} and {Wright State University, Dayton, OH} and {Banner University Medical Center – Tucson, Tucson, AZ} and {The CORE Institute, Phoenix, AZ} and {Vall d'Hebron University Hospital, Barcelona, Spain} and {Hospital Universitari Parc Tauli, Barcelona, Spain} and PREPARE and {FRASER HEALTH AUTHORITY/Royal Columbian Hospital, New Westminster, BC} and {Inova Fairfax Medical Campus, Falls Church, VA} and {Wake Forest Baptist Health, Winston-Salem, NC} and {MetroHealth Medical Center, Cleveland, OH} and {University of Utah, Salt Lake City, Utah} and {University of Mississippi Medical Center, Jackson, MS} and {Sanford Health, Sioux Falls, SD} and {Dartmouth-Hitchcock Medical Center, Lebanon, NH} and {Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC} and {University of Maryland, Capital Region Health, Largo, MD} and {University of Wisconsin Madison, Madison, WI} and {Duke University Hospital, Durham, NC} and {Brigham Women's Hospital, Boston, MA} and {University of Pennsylvania, Philadelphia, PA} and {Massachusetts General Hospital, Boston, MA} and {Bryan Medical Center, Lincoln, Nebraska} and {University of Cincinnati, Cincinnati, OH} and {Cedars-Sinai Medical Center, Los Angeles, CA} and {University of California, Irvine, Orange, CA} and Adam Boissonneault and {O Hara}, Nathan and David Pogorzelski and Lucas Marchand and Thomas Higgins and Leah Gitajn and Gage, {Mark J.} and Natoli, {Roman M.} and Ishani Sharma and Sarah Pierrie and O'Toole, {Robert V.} and Sheila Sprague and Gerard Slobogean and Slobogean, {Gerard P.} and Jeffrey Wells and Mohit Bhandari and Harris, {Anthony D.} and Mullins, {C. Daniel} and Lehana Thabane and Amber Wood and Rocca, {Gregory J.Della} and Joan Hebden and Jeray, {Kyle J.} and Marchand, {Lucas S.} and O'Hara, {Lyndsay M.} and Robert Zura and Christopher Lee and Joseph Patterson and Gardner, {Michael J.} and Jenna Blasman and Jonah Davies and Stephen Liang and Monica Taljaard and Devereaux, {P. J.} and Guyatt, {Gordon H.} and Diane Heels-Ansdell and Debra Marvel and Wells, {Jana Palmer Jeffrey} and Jeff Friedrich and O'Hara, {Nathan N.} and Frances Grissom and Gitajn, {I. Leah} and Saam Morshed and O'Toole, {Robert V.} and Petrisor, {Bradley A.} and Franca Mossuto and Joshi, {Manjari G.} and D'Alleyrand, {Jean Claude} and Justin Fowler and Jessica Rivera and Max Talbot and Shannon Dodds and Silvia Li and Alejandra Rojas and Fabbro, {Gina Del} and Szasz, {Olivia Paige} and Paula McKay and Alexandra Minea and Andrea Howe and Haley Demyanovich and Michelle Medeiros and Genevieve Polk and Eric Kettering and Nirmen Mahal and Andrew Eglseder and Aaron Johnson and Christopher Langhammer and Christopher Lebrun and Jason Nascone and Raymond Pensy and Andrew Pollak and Marcus Sciadini and Yasmin Degani and Demyanovich, {Haley K.} and Heather Phipps and Eric Hempen and Christine Holler and Petrisor, {Brad A.} and Herman Johal and Bill Ristevski and Dale Williams and Matthew Denkers and Krishan Rajaratnam and Jamal Al-Asiri and Jodi Gallant and Kaitlyn Pusztai and Sarah MacRae and Sara Renaud and Adams, {John D.} and Beckish, {Michael L.} and Bray, {Christopher C.} and Brown, {Timothy R.} and Cross, {Andrew W.} and Timothy Dew and Faucher, {Gregory K.} and Gurich, {Richard W.} and Lazarus, {David E.} and Millon, {S. John} and Moody, {M. Christian} and Palmer, {M. Jason} and Porter, {Scott E.} and Schaller, {Thomas M.} and Sridhar, {Michael S.} and Sanders, {John L.} and Rudisill, {L. Edwin} and Garitty, {Michael J.} and Poole, {Andrew S.} and Sims, {Michael L.} and Walker, {Clark M.} and Robert Carlisle and Hofer, {Erin A.} and Brandon Huggins and Michael Hunter and William Marshall and Ray, {Shea B.} and Cory Smith and Altman, {Kyle M.} and Erin Pichiotino and Quirion, {Julia C.} and Loeffler, {Markus F.} and Pichiotino, {Erin R.} and Cole, {Austin A.} and Maltz, {Ethan J.} and Wesley Parker and Ramsey, {T. Bennett} and Alex Burnikel and Michael Colello and Russell Stewart and Jeremy Wise and Matthew Anderson and Joshua Eskew and Benjamin Judkins and Miller, {James M.} and Tanner, {Stephanie L.} and Snider, {Rebecca G.} and Townsend, {Christine E.} and Pham, {Kayla H.} and Abigail Martin and Emily Robertson and Emily Bray and Sykes, {J. Wilson} and Krystina Yoder and Kelsey Conner and Harper Abbott and McKinley, {Todd O.} and Virkus, {Walter W.} and Sorkin, {Anthony T.} and Szatkowski, {Jan P.} and Mullis, {Brian H.} and Yohan Jang and Lopas, {Luke A.} and Hill, {Lauren C.} and Fentz, {Courteney L.} and Diaz, {Maricela M.} and Krista Brown and Garst, {Katelyn M.} and Denari, {Emma W.} and Patrick Osborn and Maria Herrera and Theodore Miclau and Meir Marmor and Amir Matityahu and McClellan, {R. Trigg} and David Shearer and Paul Toogood and Anthony Ding and Jothi Murali and Naga, {Ashraf El} and Jennifer Tangtiphaiboontana and Tigist Belaye and Eleni Berhaneselase and Dmitry Pokhvashchev and Obremskey, {William T.} and Jahangir, {Amir Alex} and Manish Sethi and Robert Boyce and Stinner, {Daniel J.} and Phillip Mitchell and Karen Trochez and Elsa Rodriguez and Charles Pritchett and Natalie Hogan and Moreno, {A. Fidel} and Hagen, {Jennifer E.} and Matthew Patrick and Richard Vlasak and Thomas Krupko and Michael Talerico and Marybeth Horodyski and Marissa Pazik and Elizabeth Lossada-Soto and Gary, {Joshua L.} and Warner, {Stephen J.} and Munz, {John W.} and Choo, {Andrew M.} and Achor, {Timothy S.} and Routt, {Milton L.“Chip”} and Michael Kutzler and Sterling Boutte and Warth, {Ryan J.}",

note = "Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = jun,

doi = "10.1016/j.injury.2023.03.001",

language = "English",

volume = "54",

pages = "1693--1701",

journal = "Injury",

issn = "0020-1383",

number = "6",

}

The PREP-IT Investigators, Executive Committee, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core, Patient Centred Outcomes Core, Orthopaedic Surgery Core, Operating Room Core, Infectious Disease Core, Military Core, McMaster University Methods Center (Hamilton, ON), University of Maryland School of Medicine Administrative Center (Baltimore, MD), University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD), PREP-IT Clinical Sites, Lead Clinical Site (Aqueous-PREP and PREPARE), University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD, Aqueous-PREP and PREPARE, Hamilton Health Sciences – General Site, Hamilton, ON, Prisma Health - Upstate, Greenville, SC, IU Health Methodist Hospital, Indianapolis, IN, San Antonio Military Medical Center, San Antonio, TX, University of California, San Francisco, San Francisco, CA, Aqueous-PREP, Vanderbilt Medical Center, Nashville, TN, University of Florida, Gainesville, FL, McGovern Medical School at UTHealth Houston, Houston, TX, Wright State University, Dayton, OH, Banner University Medical Center – Tucson, Tucson, AZ, The CORE Institute, Phoenix, AZ, Vall d'Hebron University Hospital, Barcelona, Spain, Hospital Universitari Parc Tauli, Barcelona, Spain, PREPARE, FRASER HEALTH AUTHORITY/Royal Columbian Hospital, New Westminster, BC, Inova Fairfax Medical Campus, Falls Church, VA, Wake Forest Baptist Health, Winston-Salem, NC, MetroHealth Medical Center, Cleveland, OH, University of Utah, Salt Lake City, Utah, University of Mississippi Medical Center, Jackson, MS, Sanford Health, Sioux Falls, SD, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC, University of Maryland, Capital Region Health, Largo, MD, University of Wisconsin Madison, Madison, WI, Duke University Hospital, Durham, NC, Brigham Women's Hospital, Boston, MA, University of Pennsylvania, Philadelphia, PA, Massachusetts General Hospital, Boston, MA, Bryan Medical Center, Lincoln, Nebraska, University of Cincinnati, Cincinnati, OH, Cedars-Sinai Medical Center, Los Angeles, CA & University of California, Irvine, Orange, CA 2023, 'The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes', Injury, vol. 54, no. 6, pp. 1693-1701. https://doi.org/10.1016/j.injury.2023.03.001

TY - JOUR

T1 - The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures

T2 - national treatment patterns and related outcomes

AU - The PREP-IT Investigators

AU - Executive Committee

AU - Steering Committee

AU - Adjudication Committee

AU - Data and Safety Monitoring Committee

AU - Research Methodology Core

AU - Patient Centred Outcomes Core

AU - Orthopaedic Surgery Core

AU - Operating Room Core

AU - Infectious Disease Core

AU - Military Core

AU - McMaster University Methods Center (Hamilton, ON)

AU - University of Maryland School of Medicine Administrative Center (Baltimore, MD)

AU - University of Maryland School of Pharmacy, The PATIENTS Program (Baltimore, MD)

AU - PREP-IT Clinical Sites

AU - Lead Clinical Site (Aqueous-PREP and PREPARE)

AU - University of Maryland School of Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD

AU - Aqueous-PREP and PREPARE

AU - Hamilton Health Sciences – General Site, Hamilton, ON

AU - Prisma Health - Upstate, Greenville, SC

AU - IU Health Methodist Hospital, Indianapolis, IN

AU - San Antonio Military Medical Center, San Antonio, TX

AU - University of California, San Francisco, San Francisco, CA

AU - Aqueous-PREP

AU - Vanderbilt Medical Center, Nashville, TN

AU - University of Florida, Gainesville, FL

AU - McGovern Medical School at UTHealth Houston, Houston, TX

AU - Wright State University, Dayton, OH

AU - Banner University Medical Center – Tucson, Tucson, AZ

AU - The CORE Institute, Phoenix, AZ

AU - Vall d'Hebron University Hospital, Barcelona, Spain

AU - Hospital Universitari Parc Tauli, Barcelona, Spain

AU - PREPARE

AU - FRASER HEALTH AUTHORITY/Royal Columbian Hospital, New Westminster, BC

AU - Inova Fairfax Medical Campus, Falls Church, VA

AU - Wake Forest Baptist Health, Winston-Salem, NC

AU - MetroHealth Medical Center, Cleveland, OH

AU - University of Utah, Salt Lake City, Utah

AU - University of Mississippi Medical Center, Jackson, MS

AU - Sanford Health, Sioux Falls, SD

AU - Dartmouth-Hitchcock Medical Center, Lebanon, NH

AU - Carolinas Medical Center, Atrium Health Musculoskeletal Institute, Charlotte, NC

AU - University of Maryland, Capital Region Health, Largo, MD

AU - University of Wisconsin Madison, Madison, WI

AU - Duke University Hospital, Durham, NC

AU - Brigham Women's Hospital, Boston, MA

AU - University of Pennsylvania, Philadelphia, PA

AU - Massachusetts General Hospital, Boston, MA

AU - Bryan Medical Center, Lincoln, Nebraska

AU - University of Cincinnati, Cincinnati, OH

AU - Cedars-Sinai Medical Center, Los Angeles, CA

AU - University of California, Irvine, Orange, CA

AU - Boissonneault, Adam

AU - O Hara, Nathan

AU - Pogorzelski, David

AU - Marchand, Lucas

AU - Higgins, Thomas

AU - Gitajn, Leah

AU - Gage, Mark J.

AU - Natoli, Roman M.

AU - Sharma, Ishani

AU - Pierrie, Sarah

AU - O'Toole, Robert V.

AU - Sprague, Sheila

AU - Slobogean, Gerard

AU - Slobogean, Gerard P.

AU - Wells, Jeffrey

AU - Bhandari, Mohit

AU - Harris, Anthony D.

AU - Mullins, C. Daniel

AU - Thabane, Lehana

AU - Wood, Amber

AU - Rocca, Gregory J.Della

AU - Hebden, Joan

AU - Jeray, Kyle J.

AU - Marchand, Lucas S.

AU - O'Hara, Lyndsay M.

AU - Zura, Robert

AU - Lee, Christopher

AU - Patterson, Joseph

AU - Gardner, Michael J.

AU - Blasman, Jenna

AU - Davies, Jonah

AU - Liang, Stephen

AU - Taljaard, Monica

AU - Devereaux, P. J.

AU - Guyatt, Gordon H.

AU - Heels-Ansdell, Diane

AU - Marvel, Debra

AU - Wells, Jana Palmer Jeffrey

AU - Friedrich, Jeff

AU - O'Hara, Nathan N.

AU - Grissom, Frances

AU - Gitajn, I. Leah

AU - Morshed, Saam

AU - O'Toole, Robert V.

AU - Petrisor, Bradley A.

AU - Mossuto, Franca

AU - Joshi, Manjari G.

AU - D'Alleyrand, Jean Claude

AU - Fowler, Justin

AU - Rivera, Jessica

AU - Talbot, Max

AU - Dodds, Shannon

AU - Li, Silvia

AU - Rojas, Alejandra

AU - Fabbro, Gina Del

AU - Szasz, Olivia Paige

AU - McKay, Paula

AU - Minea, Alexandra

AU - Howe, Andrea

AU - Demyanovich, Haley

AU - Medeiros, Michelle

AU - Polk, Genevieve

AU - Kettering, Eric

AU - Mahal, Nirmen

AU - Eglseder, Andrew

AU - Johnson, Aaron

AU - Langhammer, Christopher

AU - Lebrun, Christopher

AU - Nascone, Jason

AU - Pensy, Raymond

AU - Pollak, Andrew

AU - Sciadini, Marcus

AU - Degani, Yasmin

AU - Demyanovich, Haley K.

AU - Phipps, Heather

AU - Hempen, Eric

AU - Holler, Christine

AU - Petrisor, Brad A.

AU - Johal, Herman

AU - Ristevski, Bill

AU - Williams, Dale

AU - Denkers, Matthew

AU - Rajaratnam, Krishan

AU - Al-Asiri, Jamal

AU - Gallant, Jodi

AU - Pusztai, Kaitlyn

AU - MacRae, Sarah

AU - Renaud, Sara

AU - Adams, John D.

AU - Beckish, Michael L.

AU - Bray, Christopher C.

AU - Brown, Timothy R.

AU - Cross, Andrew W.

AU - Dew, Timothy

AU - Faucher, Gregory K.

AU - Gurich, Richard W.

AU - Lazarus, David E.

AU - Millon, S. John

AU - Moody, M. Christian

AU - Palmer, M. Jason

AU - Porter, Scott E.

AU - Schaller, Thomas M.

AU - Sridhar, Michael S.

AU - Sanders, John L.

AU - Rudisill, L. Edwin

AU - Garitty, Michael J.

AU - Poole, Andrew S.

AU - Sims, Michael L.

AU - Walker, Clark M.

AU - Carlisle, Robert

AU - Hofer, Erin A.

AU - Huggins, Brandon

AU - Hunter, Michael

AU - Marshall, William

AU - Ray, Shea B.

AU - Smith, Cory

AU - Altman, Kyle M.

AU - Pichiotino, Erin

AU - Quirion, Julia C.

AU - Loeffler, Markus F.

AU - Pichiotino, Erin R.

AU - Cole, Austin A.

AU - Maltz, Ethan J.

AU - Parker, Wesley

AU - Ramsey, T. Bennett

AU - Burnikel, Alex

AU - Colello, Michael

AU - Stewart, Russell

AU - Wise, Jeremy

AU - Anderson, Matthew

AU - Eskew, Joshua

AU - Judkins, Benjamin

AU - Miller, James M.

AU - Tanner, Stephanie L.

AU - Snider, Rebecca G.

AU - Townsend, Christine E.

AU - Pham, Kayla H.

AU - Martin, Abigail

AU - Robertson, Emily

AU - Bray, Emily

AU - Sykes, J. Wilson

AU - Yoder, Krystina

AU - Conner, Kelsey

AU - Abbott, Harper

AU - McKinley, Todd O.

AU - Virkus, Walter W.

AU - Sorkin, Anthony T.

AU - Szatkowski, Jan P.

AU - Mullis, Brian H.

AU - Jang, Yohan

AU - Lopas, Luke A.

AU - Hill, Lauren C.

AU - Fentz, Courteney L.

AU - Diaz, Maricela M.

AU - Brown, Krista

AU - Garst, Katelyn M.

AU - Denari, Emma W.

AU - Osborn, Patrick

AU - Herrera, Maria

AU - Miclau, Theodore

AU - Marmor, Meir

AU - Matityahu, Amir

AU - McClellan, R. Trigg

AU - Shearer, David

AU - Toogood, Paul

AU - Ding, Anthony

AU - Murali, Jothi

AU - Naga, Ashraf El

AU - Tangtiphaiboontana, Jennifer

AU - Belaye, Tigist

AU - Berhaneselase, Eleni

AU - Pokhvashchev, Dmitry

AU - Obremskey, William T.

AU - Jahangir, Amir Alex

AU - Sethi, Manish

AU - Boyce, Robert

AU - Stinner, Daniel J.

AU - Mitchell, Phillip

AU - Trochez, Karen

AU - Rodriguez, Elsa

AU - Pritchett, Charles

AU - Hogan, Natalie

AU - Moreno, A. Fidel

AU - Hagen, Jennifer E.

AU - Patrick, Matthew

AU - Vlasak, Richard

AU - Krupko, Thomas

AU - Talerico, Michael

AU - Horodyski, Marybeth

AU - Pazik, Marissa

AU - Lossada-Soto, Elizabeth

AU - Gary, Joshua L.

AU - Warner, Stephen J.

AU - Munz, John W.

AU - Choo, Andrew M.

AU - Achor, Timothy S.

AU - Routt, Milton L.“Chip”

AU - Kutzler, Michael

AU - Boutte, Sterling

AU - Warth, Ryan J.

PY - 2023/6

Y1 - 2023/6

N2 - Background: Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. Methods: We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results: 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). Conclusion: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.

AB - Background: Heterotopic ossification (HO) is a common complication after surgical fixation of acetabular fractures. Numerous strategies have been employed to prevent HO formation, but results are mixed and optimal treatment strategy remains controversial. The purpose of the study was to describe current national heterotopic ossification (HO) prophylaxis patterns among academic trauma centers, determine the association between prophylaxis type and radiographic HO, and identify if heterogeneity in treatment effects exist based on outcome risk strata. Methods: We used data from a subset of participants enrolled in the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. We included only patients with closed AO-type 62 acetabular fractures that were surgically treated via a posterior (Kocher-Langenbeck), combined anterior and posterior, or extensile exposure. PREPARE Clinical Trial Registration Number: NCT03523962 Patient population This cohort study was nested within the Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities (PREPARE) trial. The PREPARE trial is a multicenter cluster-randomized crossover trial evaluating the effectiveness of two alcohol-based pre-operative antiseptic skin solutions. All PREPARE trial clinical centers that enrolled at least one patient with a closed AO-type 62 acetabular fracture were invited to participate in the nested study. Results: 277 patients from 20 level 1 and level 2 trauma centers in the U.S. and Canada were included in this study. 32 patients (12%) received indomethacin prophylaxis, 100 patients (36%) received XRT prophylaxis, and 145 patients (52%) received no prophylaxis. Administration of XRT was associated with a 68% reduction in the adjusted odds of overall HO (OR 0.32, 95% CI, 0.14 – 0.69, p = 0.005). The overall severe HO (Brooker classes III or IV) rate was 8% for the entire cohort; XRT reduced the rate of severe HO in high-risk patients only (p=0.03). Conclusion: HO prophylaxis patterns after surgical fixation of acetabular fractures have changed dramatically over the last two decades. Most centers included in this study did not administer HO prophylaxis. XRT was associated with a marked reduction in the rate of overall HO and the rate of severe HO in high-risk patients. Randomized trials are needed to fully elucidate the potential benefit of XRT. PREPARE Clinical Trial Registration Number: NCT03523962.

KW - Acetabular fractures

KW - Heterotopic ossification

KW - Indomethacin prophylaxis

KW - XRT prophylaxis

UR - http://www.scopus.com/inward/record.url?scp=85151292751&partnerID=8YFLogxK

U2 - 10.1016/j.injury.2023.03.001

DO - 10.1016/j.injury.2023.03.001

M3 - Article

C2 - 37002119

AN - SCOPUS:85151292751

SN - 0020-1383

VL - 54

SP - 1693

EP - 1701

JO - Injury

JF - Injury

IS - 6

ER -

The PREP-IT Investigators, Executive Committee, Steering Committee, Adjudication Committee, Data and Safety Monitoring Committee, Research Methodology Core et al. The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes. Injury. 2023 Jun;54(6):1693-1701. doi: 10.1016/j.injury.2023.03.001

The impact of heterotopic ossification prophylaxis after surgical fixation of acetabular fractures: national treatment patterns and related outcomes

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