GeneralG02HeadInjuryHayda幻灯片.pptVIP

* Heterotopic ossification is potentiated by surgical trauma in the head injured patient. Therefore surgical methods and approaches that are less prone to HO should be chosen For instance acetabular surgery should be performed through a ilioinguinal approach rather than a posterior or extensile approach when possible. (see Webb et al (JOT 4: 376-382, 1990) noted 70% complication rate (23 patients) with acetabular fracture and a GCS 10; mostly HO with rate of 61%). Others have advocated the use of intramedullary devices rather than plating for forearm fractures to reduce the rate of synostosis (noted to be as high as 33% in a series of plated forearm fractures (Garland, CORR 176: 190-196, 1983). Prophylaxis is indicated in these high risk patients who have undergone surgery about the hip and elbow and may also be considered in nonoperatively treated elbow injuries. Single dose radiation regimens within 48 hours of surgery or indomethacin (25 mg tid for 6 wks) are both effective in reducing significant HO. In cases where motion is blocked by HO excision can be performed when process is mature and the patient can cooperate in the post surgical therapy regimen. However, recurrence is more common than in non head injured patients (50% in the proximal forearm (Failla et al JBJS 71-A: 1208-1213, 1989). * * Prevention is the key to good outcome in patients prone to contracture. These must be kept in mind at all times in the head injured patient even in the absence of overt posturing since neural input to the extremities is altered. Serial casting and manipulation are useful in the established cases. In select instances surgical releases and nerve blocks are useful in persistent contractures particularly those that are directly contributing to functional impairment or complications (decubiti). Garland D, M Rhoades. Orthopaedic Management of Brain Injured Adults, CORR 131:111-120, 1978. * * Demetraiades D, K Charalambides, S Chahwan et al: Nonskeletal cervical