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Introduction/Background Heterotopic ossification (HO) is a frequent complication after damage to the central nervous system (CNS), with an estimated prevalence of up to 76%. The primary site of HO is the hip joint (60,9%). The only effective treatment of troublesome HO is surgery. The main purpose of this study was to identify the relationship between the location of troublesome hip HO treated by surgery and the etiology of the cerebral damage. The secondary aim was to identify risk factor of sepsis and recurrences after the surgery. Material and method We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery for troublesome HO from 1993 to 2016 (417 patients, 609 surgeries). Results The sites of HO on the hip joint were associated with its etiology ( P < 0.01): for brain damaged patients, the hip HO was most frequently anterior and internal with a rate of 40.0% whereas it was anterior for patients with spinal cord injury (SCI), with a rate of 54.4%. The main side effect after surgery of troublesome HO was sepsis, with a rate of revision surgery of 8.2%. SCI patients were more affected (18.3%) than traumatically brain injured patients (TBI) (4.4%) or stroke patients (8.7%). Sepsis seemed to occur most frequently on hip surgeries, but no statistically significant relationship was found. The rate of recurrence was 2.8% for the whole population. It occurred most frequently after TBI (3.6%) rather than after stroke (1.9%) or SCI (1.5%). Conclusion The sites of hip HO, their recurrences and sepsis were associated with its etiology. The patients with SCI will develop most frequently anterior hip HO, with a risk of sepsis that is more frequent than in the other etiologies. [ABSTRACT FROM AUTHOR]

Introduction/Background Neurogenic heterotopic ossification (NHO) of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. Our practice of heterotopic ossification surgery has progressed during our experience, becoming better adapted to the pathology and to the patients, who are often fragile and show neurologic sequelae. We want to give a feedback of the lessons we learned in the Raymond-Poincaré Hospital about NHO resection. Material and method In total, 377 first-line procedures were performed for heterotopic ossification of the hip between 1993 and November 2016. Surgery requires rigorous organization and planning, preferably in a rehabilitation department, by a multidisciplinary team experienced in this pathology. Preoperative work-up should include contrast-enhanced CT; scintigraphy is non-contributive. Indications for surgery are decided in a multidisciplinary team meeting, with a contract laying out expected functional gain. It is this contract that determines the extent of resection, without seeking complete resection, which would incur an increased risk of complications. Results The surgical approach and resection strategy depend on lesion location and any resulting neurovascular compression. In our own series, 3,5% of patients required revision for recurrence. The most common complications is infection: 10.3% in our experience, with wide variation according to location. No adjuvant treatments have demonstrated efficacy against recurrence. Conclusion Surgical treatment of heterotopic ossification of the hip is reliable when performed in an adapted center by an experienced multidisciplinary team. Clinical results are satisfactory. There remains, however, a risk of sepsis, especially with medullary injuries. [ABSTRACT FROM AUTHOR]

Introduction Optimising the first model developing heterotopic ossification (HO) on paraplegic mouse requires the study of cardiotoxin intramuscular injection substitution by a mechanical injury. Two lines of research were developed: pressure by extended crush and brief high-energy physical impact, with and without IM injection of LPS (purified bacterial lipopolysaccharides). Material The first kind of mechanical injury evaluated was the crush with a pressure manometer Jamar ® . The hamstring of the hind limbs of five groups of paraplegic mice underwent pressure forces from 2.5 to 10 kg with compression length going from 5 to 25 seconds. The second involved a brief high-energy physical impact on thigh muscles through an impactor, making possible a defined and reproducible soft tissue contusion. The hamstring of hind limbs of 2 subgroups of paraplegic mice underwent 2 different forces of muscular impact (energy for impact 1 = 0.19 J & for impact 2 = 0.32 J). In these two experiments, a spinal cord injury of T6 level was made, associated or not to LPS injection. The presence and the volume of the HO was measured by μCT after fixation and decalcification. Results There was no HO: (1) in the different groups after muscular crush and in the control groups with and without injection of LPS in the hamstring. (2) Neither in the brief high-energy impact without LPS groups. On the other hand, we found HO in the hamstrings of the brief high-energy impact with LPS injection group ( n = 7 mice) (mean volume: 0.355 mm 3 for impact 1 and 0.76 mm 3 for impact 2; mean density: 209.75 mg HA/cm 2 for impact 1 and 265.5 mg HA/cm 2 for impact 2). Discussion A brief high-energy impact could contribute to the damage mechanism favouring HO development. Extended muscular crush doesn’t seem to be involved. LPS role needs to be specifically study because it injection has to be associated with the brief high-energy impact. [ABSTRACT FROM AUTHOR]

Objectives Life after a burn is conditioned by the sequelae that can persist. Heterotopic ossifications may result in limitations of range of motion and functional impairment. Physiopathology and risk factors are still poorly understood. The purpose was to study the epidemiology of patients managed in burn care center, and to study the potential role of length of stay in burn care center, cutaneous, pulmonary and urinary infections, total and deep body burnt area, use of curare and use of air fluidized bed and their duration of use on the development of heterotopic ossifications. Methods It is a case control study. We studied the medical records of patients managed in Percy hospital burn care center, from January 1st, 2009 to December 31st, 2013, and then sent in the rehabilitation centers La Musse and Coubert or in Percy hospital. Results Eight hundred and five patients were included. Thirty-two patients (4%) developed 74 heterotopic ossifications. Heterotopic ossifications were mainly localized around elbows, then around hips, shoulders and knees. Each patient was associated with 3 controls. We found a significant association between length of stay in burn care center, total and deep burnt surfaces, pulmonary or cutaneous infection, utilisation of curare and utilisation of air fluidized bed and its duration of use, and heterotopic ossification development. Discussion The epidemiology of our population and of heterotopic ossification is similar to that found in the literature. We confirmed the suspected risk factors. We identified two new elements: utilisation of curare and of air fluidized bed; the association was significant. The role of these two elements is not clear; we need specific studies to understand. We also need superior level of evidence studies to confirm our results. [ABSTRACT FROM AUTHOR]