Authors
Stogov M. V.
Doctor of Biology, Assistant Professor, Leading Researcher, Biochemistry Laboratory1
Soldatov Y. P.
Doctor of Medicine, Professor, Head, Educational Department1
Chibirov G. M.
MD PhD, Head, Trauma and Orthopedic Department ¹ 181
Kireeva E. A.
PhD in Biology, Senior Researcher, Biochemistry Laboratory1
1 - Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan, Russian Federation
Corresponding Author
Maksim V. Stogov, e-mail: stogo_off@list.ru
Conflict of interest
None declared.
Funding
The study had no sponsorship.
Abstract
Heterotopic ossification (HO) is a common complication after injuries and orthopedic interventions. The aim of the study is to assess the feasibility of using laboratory tests to predict and determine the degree of risk of developing heterotopic ossification in patients after surgical treatment of bone fractures. Materials and methods. The results of surgical treatment of the effects of a humeral fracture in 25 patients were analyzed. In retrospect, all patients were divided into two groups: the main group included patients (n=9), who after surgery of the elbow fractures developed complications in the form of HO elbow para-articular tissues. The control group (n=16) consisted of patients who in the year after elbow fractures surgery developed no complications in the form of HO. Blood tests were performed in all patients prior to treatment, 7 days after surgery and at discharge from the hospital. The two groups of comparison (main and control) were comparable in age, time elapsed from the injury, the type of surgery performed, and length of hospital stay. Results. As a result of the study three potential predictors of HO were distinguished by laboratory tests in patients of the main group at the time of discharge: 1) high values of lactate (cut point with 100% sensitivity of the test – 2.32 mmol/l); 2) high values of hemoglobin (cut point with 100% sensitivity of the test – 130 g/l); 3) decreased activity of bone isoenzyme of acid phosphatase (cut point with 100% sensitivity of the test – 4.4 U/l). The odds ratio for a positive result of all three tests for predicting heterotopic ossification is 15.0. Conclusion. The identified laboratory tests allow to predict and determine the degree of risk of heterotopic ossification in patients after treatment of the effects of bone fractures.
Key words
heterotopic ossification, blood biochemistry, complete blood count, orthopedics
DOI
References
1. Elfimov S.V., Trifonova E.B., Makarova E.B., Osipenko A.V. Laboratornyy monitoring patsientov s geteretopicheskoy ossifikatsiey posle endoprotezirovaniya tazobedrennogo sustava [Laboratory monitoring of patients with heterotopic ossification after total hip arthroplasty]. Geniy ortopedii [Genij Ortopedii] 2009; (3): 78-81. (In Russ.)
2. Ovsyankin N.A. Oshibki pri vosstanovitel'nom lechenii detey s povrezhdeniem loktevogo sustava [Errors at restorative treatment of children with elbow injuries]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia] 2010; (3): 118-125. (In Russ.). doi:10.21823/2311-2905-2010-0-3-118-125
3. Soldatov Yu.P., Makushin V.D., Chepeleva M.V. Profilaktika posleoperatsionnoy ossifikatsii tkaney loktevogo sustava [Prevention of the postoperative ossification of the elbow tissues]. Geniy ortopedii [Genij Ortopedii] 2005; 3: 11-14. (In Russ.).
4. Bauer A.S., Lawson B.K., Bliss R.L., Dyer G.S. Risk factors for posttraumatic heterotopic ossification of the elbow: case-control study. J. Hand Surg. Am. 2012; 37(7): 1422-1429.e1-6. doi: 10.1016/j.jhsa.2012.03.013
5. Bitter T., Muir H.M. A modified uronic acid carbazole reactions. Anal. Biochem. 1962; 4(4): 330-334.
6. Cai J., Wang W., Yan H., Sun Y., Chen W., Chen S., Fan C. Complications of open elbow arthrolysis in post-traumatic elbow stiffness: a systematic review. PLoS One 2015; 10(9): e0138547. doi: 10.1371/journal.pone.0138547
7. Cheung E.V., Sarkissian E.J. Complications of Elbow Trauma. Hand Clin. 2015; 31(4): 683-691. doi: 10.1016/j.hcl.2015.06.012
8. Foruria A.M., Augustin S., Morrey B.F., Sanchez-Sotelo J.J. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. Bone Joint Surg. Am. 2013; 95(10): e66. doi: 10.2106/JBJS.L.00302
9. Foruria A.M., Lawrence T.M., Augustin S., Morrey B.F., Sanchez-Sotelo J. Heterotopic ossification after surgery for distal humeral fractures. Bone Joint J. 2014; 96-B(12): 1681-1687. doi: 10.1302/0301-620X.96B12.34091
10. Ranganathan K., Loder S., Agarwal S., Wong V.W., Forsberg J., Davis T.A., Wang S., James A.W., Levi B. Heterotopic ossification: basic-science principles and clinical correlates. J. Bone Joint Surg. Am. 2015; 97(13): 1101-1111. doi: 10.2106/JBJS.N.01056
11. Salazar D., Golz A., Israel H., Marra G. Heterotopic ossification of the elbow treated with surgical resection: risk factors, bony ankylosis, and complications. Clin. Orthop. Relat. Res. 2014; 472(7): 2269-2275. doi: 10.1007/s11999-014-3591-0
12. Wiggers J.K., Helmerhorst G.T., Brouwer K.M., Niekel M.C., Nunez F., Ring D. Injury complexity factors predict heterotopic ossification restricting motion after elbow trauma. Clin. Orthop. Relat. Res. 2014; 472(7): 2162-2167. doi: 10.1007/s11999-013-3304-0
13. Wilkinson J.M., Stockley .I, Hamer A.J., Barrington N.A., Eastell R. Biochemical markers of bone turnover and development of heterotopic ossification after total hip arthroplasty. J. Orthop. Res. 2003; 21(3): 529-534. doi: 10.1016/S0736-0266(02)00236-X
