1
|
Dehghani M, Pourmontaseri H. Aetiology, risk factors and treatment of typical and atypical pressure ulcers in patients with traumatic brain injury: A narrative review. Int Wound J 2024; 21:e14788. [PMID: 38420873 PMCID: PMC10902764 DOI: 10.1111/iwj.14788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Pressure ulcers are one of the leading complications in bedridden patients that result in multiple burdens on healthcare systems and patients (11 billion dollars/year). The prevalence of pressure ulcers in traumatic brain injury patients is 1.5-fold compared with the other bedridden patients. Moreover, critical traumatic brain injury patients who are admitted to the intensive care unit experience severe pressure ulcers and further complications. The motor/sensory disabilities and low supplementation and oxygenation to the pressured side were the main mechanisms of the typical pressure ulcers. Intellectual evaluation is the first essential step to prevent the development of pressure ulcers in high-risk patients. Till now, different scales, including Injury Scale Score and Braden Scale Score, have been provided to assess the pressure ulcer. Since low stages of pressure ulcers heal rapidly, traumatic brain injury patients require a periodical assessment to prevent further developments timely. Alongside different procedures provided to prevent and treat any pressure ulcer, traumatic brain injury patients required additional specific protections. For the first line, fast and efficient rehabilitation repairs motor/sensory disabilities and decreases the chance of pressure ulcer. Our review indicated that pressure ulcer in traumatic brain injury had several complex mechanisms that demand special care. Therefore, further studies are required to address these mechanisms and prevent their progression to typical and atypical pressure ulcers.
Collapse
Affiliation(s)
- Mohammadreza Dehghani
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical SciencesFasaIran
- Projects Support Division, Medical Students AssociationFasa University of Medical SciencesFasaIran
| |
Collapse
|
2
|
Lu W, Yan J, Wang C, Qin W, Han X, Qin Z, Wei Y, Xu H, Gao J, Gao C, Ye T, Tay FR, Niu L, Jiao K. Interorgan communication in neurogenic heterotopic ossification: the role of brain-derived extracellular vesicles. Bone Res 2024; 12:11. [PMID: 38383487 PMCID: PMC10881583 DOI: 10.1038/s41413-023-00310-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/06/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024] Open
Abstract
Brain-derived extracellular vesicles participate in interorgan communication after traumatic brain injury by transporting pathogens to initiate secondary injury. Inflammasome-related proteins encapsulated in brain-derived extracellular vesicles can cross the blood‒brain barrier to reach distal tissues. These proteins initiate inflammatory dysfunction, such as neurogenic heterotopic ossification. This recurrent condition is highly debilitating to patients because of its relatively unknown pathogenesis and the lack of effective prophylactic intervention strategies. Accordingly, a rat model of neurogenic heterotopic ossification induced by combined traumatic brain injury and achillotenotomy was developed to address these two issues. Histological examination of the injured tendon revealed the coexistence of ectopic calcification and fibroblast pyroptosis. The relationships among brain-derived extracellular vesicles, fibroblast pyroptosis and ectopic calcification were further investigated in vitro and in vivo. Intravenous injection of the pyroptosis inhibitor Ac-YVAD-cmk reversed the development of neurogenic heterotopic ossification in vivo. The present work highlights the role of brain-derived extracellular vesicles in the pathogenesis of neurogenic heterotopic ossification and offers a potential strategy for preventing neurogenic heterotopic ossification after traumatic brain injury. Brain-derived extracellular vesicles (BEVs) are released after traumatic brain injury. These BEVs contain pathogens and participate in interorgan communication to initiate secondary injury in distal tissues. After achillotenotomy, the phagocytosis of BEVs by fibroblasts induces pyroptosis, which is a highly inflammatory form of lytic programmed cell death, in the injured tendon. Fibroblast pyroptosis leads to an increase in calcium and phosphorus concentrations and creates a microenvironment that promotes osteogenesis. Intravenous injection of the pyroptosis inhibitor Ac-YVAD-cmk suppressed fibroblast pyroptosis and effectively prevented the onset of heterotopic ossification after neuronal injury. The use of a pyroptosis inhibitor represents a potential strategy for the treatment of neurogenic heterotopic ossification.
Collapse
Affiliation(s)
- Weicheng Lu
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jianfei Yan
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chenyu Wang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Wenpin Qin
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaoxiao Han
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Zixuan Qin
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yu Wei
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Haoqing Xu
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jialu Gao
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Changhe Gao
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Tao Ye
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Franklin R Tay
- The Dental College of Georgia, Augusta University, Augusta, GA, USA
| | - Lina Niu
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Stomatology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Kai Jiao
- Department of Stomatology, Tangdu Hospital & State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration & School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.
| |
Collapse
|
3
|
Salga M, Samuel SG, Tseng HW, Gatin L, Girard D, Rival B, Barbier V, Bisht K, Shatunova S, Debaud C, Winkler IG, Paquereau J, Dinh A, Genêt G, Kerever S, Abback PS, Banzet S, Genêt F, Lévesque JP, Alexander KA. Bacterial Lipopolysaccharides Exacerbate Neurogenic Heterotopic Ossification Development. J Bone Miner Res 2023; 38:1700-1717. [PMID: 37602772 DOI: 10.1002/jbmr.4905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 08/22/2023]
Abstract
Neurogenic heterotopic ossifications (NHO) are heterotopic bones that develop in periarticular muscles after severe central nervous system (CNS) injuries. Several retrospective studies have shown that NHO prevalence is higher in patients who suffer concomitant infections. However, it is unclear whether these infections directly contribute to NHO development or reflect the immunodepression observed in patients with CNS injury. Using our mouse model of NHO induced by spinal cord injury (SCI) between vertebrae T11 to T13 , we demonstrate that lipopolysaccharides (LPS) from gram-negative bacteria exacerbate NHO development in a toll-like receptor-4 (TLR4)-dependent manner, signaling through the TIR-domain-containing adapter-inducing interferon-β (TRIF/TICAM1) adaptor rather than the myeloid differentiation primary response-88 (MYD88) adaptor. We find that T11 to T13 SCI did not significantly alter intestinal integrity nor cause intestinal bacteria translocation or endotoxemia, suggesting that NHO development is not driven by endotoxins from the gut in this model of SCI-induced NHO. Relevant to the human pathology, LPS increased expression of osteoblast markers in cultures of human fibro-adipogenic progenitors isolated from muscles surrounding NHO biopsies. In a case-control retrospective study in patients with traumatic brain injuries, infections with gram-negative Pseudomonas species were significantly associated with NHO development. Together these data suggest a functional association between gram-negative bacterial infections and NHO development and highlights infection management as a key consideration to avoid NHO development in patients. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Marjorie Salga
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
- University of Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR Simone Veil-Santé, Montigny le Bretonneux, France
- UPOH (Unité Péri Opératoire du Handicap), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Selwin G Samuel
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Chennai, India
| | - Hsu-Wen Tseng
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Laure Gatin
- University of Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR Simone Veil-Santé, Montigny le Bretonneux, France
- UPOH (Unité Péri Opératoire du Handicap), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
- Department of Orthopedic Surgery, Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Dorothée Girard
- Institut de Recherche Biomédicale des Armées (IRBA), INSERM UMR-MD 1197, Clamart, France
| | - Bastien Rival
- Institut de Recherche Biomédicale des Armées (IRBA), INSERM UMR-MD 1197, Clamart, France
| | - Valérie Barbier
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Kavita Bisht
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Svetlana Shatunova
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Charlotte Debaud
- University of Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR Simone Veil-Santé, Montigny le Bretonneux, France
| | - Ingrid G Winkler
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Julie Paquereau
- UPOH (Unité Péri Opératoire du Handicap), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Aurélien Dinh
- Department of Infectious Diseases, Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Guillaume Genêt
- University of Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR Simone Veil-Santé, Montigny le Bretonneux, France
| | - Sébastien Kerever
- Department of Anesthesiology and Critical Care, Lariboisière University Hospital, AP-HP, Paris, France
| | - Paer-Sélim Abback
- Department of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP, Clichy, France
| | - Sébastien Banzet
- Institut de Recherche Biomédicale des Armées (IRBA), INSERM UMR-MD 1197, Clamart, France
| | - François Genêt
- University of Versailles Saint Quentin en Yvelines, END:ICAP U1179 INSERM, UFR Simone Veil-Santé, Montigny le Bretonneux, France
- UPOH (Unité Péri Opératoire du Handicap), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Jean-Pierre Lévesque
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| | - Kylie A Alexander
- Mater Research Institute-The University of Queensland, Translational Research Institute, Woolloongabba, Australia
| |
Collapse
|
4
|
Estraneo A, Pascarella A, Masotta O, Bartolo M, Pistoia F, Perin C, Marino S, Lucca L, Pingue V, Casanova E, Romoli AM, Gentile S, Formisano R, Salvi GP, Scarponi F, De Tanti A, Bongioanni P, Rossato E, Santangelo A, Diana AR, Gambarin M, Intiso D, Antenucci R, Premoselli S, Bertoni M, Trojano L. Multi-center observational study on occurrence and related clinical factors of neurogenic heterotopic ossification in patients with disorders of consciousness. Brain Inj 2021; 35:530-535. [PMID: 33734911 DOI: 10.1080/02699052.2021.1893384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Aims: to assess occurrence and clinical correlates of neurogenic heterotopic ossifications (NHO) in patients with prolonged disorder of consciousness (DoC).Design: multi-center cross-sectional observational study.Setting: 23 intensive neurorehabilitation units.Subjects: 287 patients with prolonged disorder of consciousness (DoC; 150 in vegetative state, VS, and 128 in minimally conscious state, MCS) of different etiology (vascular = 125, traumatic = 83, anoxic = 56, others = 14).Main Measures: clinical evidence of NHO confirmed by standard radiological and/or sonographic evaluation; Coma Recovery Scale-Revised; Disability Rating Scale (DRS); Early Rehabilitation Barthel Index; presence of ventilator support, spasticity, bone fractures and paroxysmal sympathetic hyperactivity.Results: 31 patients (11.2%) presented NHO. Univariate analyses showed that NHO was associated with VS diagnosis, traumatic etiology, high DRS category and total score, and high occurrence of limb spasticity and bone fractures. A cluster-corrected binary logistic regression model (excluding spasticity available in a subset of patients) showed that only lower DRS total score and presence of bone fractures were independently associated with NHO.Conclusions: NHO are relatively frequent in patients with DoC, and are independently associated with functional disability, bone fractures and spasticity. These findings contribute to identifying patients with DoC prone to develop NHO and requiring special interventions to improve functional recovery.
Collapse
Affiliation(s)
- A Estraneo
- Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neurology Unit, Santa Maria Della Pietà General Hospital, Nola, Italy
| | - A Pascarella
- Lab for DoC Study, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A., Telese Terme (BN), Italy
| | - O Masotta
- Lab for DoC Study, Istituti Clinici Scientifici Maugeri IRCCS, SB S.p.A., Telese Terme (BN), Italy
| | - M Bartolo
- Neurorehabilitation Unit, HABILITA Zingonia/Ciserano, Bergamo, Italy
| | - F Pistoia
- Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, L'Aquila, Italy
| | - C Perin
- Unità di Neuroriabilitazione cognitiva, Istituti Clinici Zucchi, Carate Brianza, Italy
| | - S Marino
- Neurorehabilitation Unit, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - L Lucca
- Neurorehabilitation Unit, Istituto S. Anna, Crotone, Italy
| | - V Pingue
- Neurorehabilitation and Spinal Unit, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - E Casanova
- UO Di Medicina Riabilitativa E Neuroriabilitazione, IRCCS Istituto Delle Scienze Neurologiche Di Bologna, Bologna, Italy
| | - A M Romoli
- Department of Acquired Brain Injury, IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Gentile
- Dipartimento Riabilitazione F.T. Camplani Clinica Ancelle Carità, Cremona, Italy
| | | | - G P Salvi
- U.F. Riabilitazione Neuromotoria Istituto Clinico Quarenghi, S. Pellegrino Terme, Italy
| | - F Scarponi
- Dipartimento Neurologia UGCA Ospedale S. Giovanni Battista, Foligno, Italy
| | - A De Tanti
- Neurorehabilitation Unit, Centro Cardinal Ferrari, S, Stefano, Fontanellato di Parma, Italy, Centro Cardinal Ferrari, S. Stefano Riabilitazione, Fontanellato Di Parma, Italy
| | - P Bongioanni
- sABI Section, Integrated Care Dept of Medical Specialties, AO-Universitaria Pisana, Pisa, Italy
| | - E Rossato
- Dipartimento Di Riabilitazione, IRCCS Ospedale Sacro Cuore Don Calabria - Negrar, Verona, Italy
| | - A Santangelo
- Rehabilitation Dept, Giuseppe Giglio Foundation, Unit for Severe Acquired Brain Injuries, Cefalù, Italy
| | - A R Diana
- Dip. Neuroscienze e Riabilitazione, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - M Gambarin
- Unità di Medicina Fisica e Riabilitazione, Ospedale Riabilitativo Di Marzana, Verona, Italy
| | - D Intiso
- Unità di Medicina Fisica e Neuroriabilitazione, IRCCS "Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | - R Antenucci
- Medicina Riabilitativa Intensiva- Ospedale Castel San Giovanni, Italy
| | - S Premoselli
- UOC Di Riabilitazione Neuromotoria Specialistica, Unità Comi ASST, Vimercate, Monza, Italy
| | - M Bertoni
- Azienda Socio Sanitaria Territoriale Dei Sette Laghi- Presidio Di Riabilitazione Neuromotoria, Cuasso Al Monte, Italy
| | - L Trojano
- IRCCS, Fondazione Santa Lucia, Rome, Italy.,Department of Psychology, University of Campania 'Luigi Vanvitelli', Caserta, Italy
| |
Collapse
|
5
|
Girard D, Torossian F, Oberlin E, Alexander KA, Gueguen J, Tseng HW, Genêt F, Lataillade JJ, Salga M, Levesque JP, Le Bousse-Kerdilès MC, Banzet S. Neurogenic Heterotopic Ossifications Recapitulate Hematopoietic Stem Cell Niche Development Within an Adult Osteogenic Muscle Environment. Front Cell Dev Biol 2021; 9:611842. [PMID: 33748104 PMCID: PMC7973025 DOI: 10.3389/fcell.2021.611842] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/17/2021] [Indexed: 12/11/2022] Open
Abstract
Hematopoiesis and bone interact in various developmental and pathological processes. Neurogenic heterotopic ossifications (NHO) are the formation of ectopic hematopoietic bones in peri-articular muscles that develop following severe lesions of the central nervous system such as traumatic cerebral or spinal injuries or strokes. This review will focus on the hematopoietic facet of NHO. The characterization of NHO demonstrates the presence of hematopoietic marrow in which quiescent hematopoietic stem cells (HSC) are maintained by a functional stromal microenvironment, thus documenting that NHOs are neo-formed ectopic HSC niches. Similarly to adult bone marrow, the NHO permissive environment supports HSC maintenance, proliferation and differentiation through bidirectional signaling with mesenchymal stromal cells and endothelial cells, involving cell adhesion molecules, membrane-bound growth factors, hormones, and secreted matrix proteins. The participation of the nervous system, macrophages and inflammatory cytokines including oncostatin M and transforming growth factor (TGF)-β in this process, reveals how neural circuitry fine-tunes the inflammatory response to generate hematopoietic bones in injured muscles. The localization of NHOs in the peri-articular muscle environment also suggests a role of muscle mesenchymal cells and bone metabolism in development of hematopoiesis in adults. Little is known about the establishment of bone marrow niches and the regulation of HSC cycling during fetal development. Similarities between NHO and development of fetal bones make NHOs an interesting model to study the establishment of bone marrow hematopoiesis during development. Conversely, identification of stage-specific factors that specify HSC developmental state during fetal bone development will give more mechanistic insights into NHO.
Collapse
Affiliation(s)
- Dorothée Girard
- INSERM UMRS-MD 1197, Institut de Recherche Biomédicale des Armées (IRBA), Clamart, France
| | - Frédéric Torossian
- INSERM UMRS-MD 1197, Université Paris-Saclay, Hôpital Paul Brousse, Villejuif, France
| | - Estelle Oberlin
- INSERM UMRS-MD 1197, Université Paris-Saclay, Hôpital Paul Brousse, Villejuif, France
| | - Kylie A. Alexander
- Mater Research Institute—The University of Queensland, Woolloongabba, QLD, Australia
| | - Jules Gueguen
- INSERM UMRS-MD 1197, Institut de Recherche Biomédicale des Armées (IRBA), Clamart, France
| | - Hsu-Wen Tseng
- Mater Research Institute—The University of Queensland, Woolloongabba, QLD, Australia
| | - François Genêt
- INSERM U1179, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
| | | | - Marjorie Salga
- INSERM U1179, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Versailles, France
| | - Jean-Pierre Levesque
- Mater Research Institute—The University of Queensland, Woolloongabba, QLD, Australia
| | | | - Sébastien Banzet
- INSERM UMRS-MD 1197, Institut de Recherche Biomédicale des Armées (IRBA), Clamart, France
| |
Collapse
|
6
|
Carpentier VT, Salga M, Gatin L, Genêt F, Paquereau J. Early diagnosis of heterotopic ossification among patients admitted to a neurological Post-Intensive Care Rehabilitation Unit. Eur J Phys Rehabil Med 2021; 57:527-534. [PMID: 33448758 DOI: 10.23736/s1973-9087.21.06589-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Heterotopic ossification (HO) is defined as the formation of endochondral bone within soft tissue. Non-genetic forms, mainly corresponding to a consequence of bone, brain or spinal cord injury, are the most common. HO leads to important functional limitations and alteration of quality of life. To our knowledge, the time between brain, bone, or spinal cord injury and clinical suspicion of HO has never been studied. By admitting patients with severe neurological disorders, we hypothesized that the prevalence of HO in neurological post-intensive care rehabilitation units (PICRU) might be significant as these patients have recognized risk factors for HO. AIM This study aimed to investigate HO among patients admitted to a neurological PICRU with two objectives: 1) to describe the prevalence of HO in PICRU; 2) to assess the time between neurological disorder, clinical suspicion of HO and radiological diagnosis. DESIGN A monocentric retrospective cohort study. SETTING PICRU in our public university teaching hospital. This inpatient referral department is specifically dedicated to the early discharge from Intensive Care Units (ICU) of patients with severe neurological impairment who need rehabilitation. POPULATION We study all patients admitted between April 2016 and January 2019. One hundred twenty-five subjects were admitted for a rehabilitation program after neuro-trauma or stroke. We included all first-time stays in PICRU lasting 7 days or longer. METHODS Retrospective data extraction using administrative data from an electronic patient management program was done to select eligible subjects. Included subjects were then identified by a retrospective review of electronic inpatient medical records after patient discharge. Data of interest were collected from these same medical records. RESULTS Forty-four HO were diagnosed in 24 subjects (24/125; 19%), with a median number of 2 [1; 2] HO per subject. Neurological trauma was the main reason for admission to ICU (89/125; 71%) and half of patients had a traumatic brain injury (TBI) (67/125; 54%). The diagnosis of HO was made in PICRU in 75% of cases. Clinical suspicion of HO (autonomic dysfunction, local inflammatory signs, pain, or reduced joint range of motion) was made 6 [5; 7] weeks after admission to ICU. Radiological confirmation of clinical suspicion or fortuitous diagnosis by imaging (50% of the cases) occurred 8 [7; 12] weeks after admission to ICU. The median time of clinical suspicion or radiological diagnosis was 1 week after admission to PICRU. CONCLUSIONS HO is a sub-acute complication which develops in patients admitted to ICU for severe central nervous system disorders as clinical suspicion or radiological confirmation of diagnosis was made within the first week after admission in neurological PICRU (i.e. 6 to 8 weeks after ICU admission). CLINICAL REHABILITATION IMPACT As treatment for HO may at least partially improves rehabilitation and quality of life, we recommend a systematic screening in PICRU patients for HO by clinical examination supplemented by imaging in case of suspicion.
Collapse
Affiliation(s)
- Vincent T Carpentier
- Department of Physical Medicine and Rehabilitation, CIC-IT 1429, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France.,Faculty of Medicine, University of Paris, Paris, France.,Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
| | - Marjorie Salga
- Department of Physical Medicine and Rehabilitation, CIC-IT 1429, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France.,Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France.,U1179 END-ICAP, Inserm, UFR Simone Veil - Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), Paris Saclay University, Montigny-le-Bretonneux, France
| | - Laure Gatin
- Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France.,U1179 END-ICAP, Inserm, UFR Simone Veil - Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), Paris Saclay University, Montigny-le-Bretonneux, France.,Department of Orthopedic Surgery, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France
| | - François Genêt
- Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France.,U1179 END-ICAP, Inserm, UFR Simone Veil - Santé, Versailles Saint-Quentin-en-Yvelines University (UVSQ), Paris Saclay University, Montigny-le-Bretonneux, France
| | - Julie Paquereau
- Department of Physical Medicine and Rehabilitation, CIC-IT 1429, Raymond-Poincaré Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Garches, France - .,Garches Neuro-Orthopedics Research Group (GRENOG), Garches, France
| |
Collapse
|
7
|
Wong KR, Mychasiuk R, O'Brien TJ, Shultz SR, McDonald SJ, Brady RD. Neurological heterotopic ossification: novel mechanisms, prognostic biomarkers and prophylactic therapies. Bone Res 2020; 8:42. [PMID: 33298867 PMCID: PMC7725771 DOI: 10.1038/s41413-020-00119-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Neurological heterotopic ossification (NHO) is a debilitating condition where bone forms in soft tissue, such as muscle surrounding the hip and knee, following an injury to the brain or spinal cord. This abnormal formation of bone can result in nerve impingement, pain, contractures and impaired movement. Patients are often diagnosed with NHO after the bone tissue has completely mineralised, leaving invasive surgical resection the only remaining treatment option. Surgical resection of NHO creates potential for added complications, particularly in patients with concomitant injury to the central nervous system (CNS). Although recent work has begun to shed light on the physiological mechanisms involved in NHO, there remains a significant knowledge gap related to the prognostic biomarkers and prophylactic treatments which are necessary to prevent NHO and optimise patient outcomes. This article reviews the current understanding pertaining to NHO epidemiology, pathobiology, biomarkers and treatment options. In particular, we focus on how concomitant CNS injury may drive ectopic bone formation and discuss considerations for treating polytrauma patients with NHO. We conclude that understanding of the pathogenesis of NHO is rapidly advancing, and as such, there is the strong potential for future research to unearth methods capable of identifying patients likely to develop NHO, and targeted treatments to prevent its manifestation.
Collapse
Affiliation(s)
- Ker Rui Wong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
| |
Collapse
|
8
|
Alexander KA, Tseng HW, Salga M, Genêt F, Levesque JP. When the Nervous System Turns Skeletal Muscles into Bones: How to Solve the Conundrum of Neurogenic Heterotopic Ossification. Curr Osteoporos Rep 2020; 18:666-676. [PMID: 33085000 DOI: 10.1007/s11914-020-00636-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Neurogenic heterotopic ossification (NHO) is the abnormal formation of extra-skeletal bones in periarticular muscles after damage to the central nervous system (CNS) such as spinal cord injury (SCI), traumatic brain injury (TBI), stroke, or cerebral anoxia. The purpose of this review is to summarize recent developments in the understanding of NHO pathophysiology and pathogenesis. Recent animal models of NHO and recent findings investigating the communication between CNS injury, tissue inflammation, and upcoming NHO therapeutics are discussed. RECENT FINDINGS Animal models of NHO following TBI or SCI have shown that NHO requires the combined effects of a severe CNS injury and soft tissue damage, in particular muscular inflammation and the infiltration of macrophages into damaged muscles plays a key role. In the context of a CNS injury, the inflammatory response to soft tissue damage is exaggerated and persistent with excessive signaling via substance P-, oncostatin M-, and TGF-β1-mediated pathways. This review provides an overview of the known animal models and mechanisms of NHO and current therapeutic interventions for NHO patients. While some of the inflammatory mechanisms leading to NHO are common with other forms of traumatic and genetic heterotopic ossifications (HO), NHOs uniquely involve systemic changes in response to CNS injury. Future research into these CNS-mediated mechanisms is likely to reveal new targetable pathways to prevent NHO development in patients.
Collapse
Affiliation(s)
- Kylie A Alexander
- Mater Research Institute, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Queensland, 4102, Australia
| | - Hsu-Wen Tseng
- Mater Research Institute, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Queensland, 4102, Australia
| | - Marjorie Salga
- Department of Physical Medicine and Rehabilitation, CIC 1429, Raymond Poincaré Hospital, APHP, Garches, France
- END:ICAP U1179 INSERM, University of Versailles Saint Quentin en Yvelines, UFR Simone Veil-Santé, Montigny le Bretonneux, France
| | - François Genêt
- Department of Physical Medicine and Rehabilitation, CIC 1429, Raymond Poincaré Hospital, APHP, Garches, France
- END:ICAP U1179 INSERM, University of Versailles Saint Quentin en Yvelines, UFR Simone Veil-Santé, Montigny le Bretonneux, France
| | - Jean-Pierre Levesque
- Mater Research Institute, The University of Queensland, Translational Research Institute, 37 Kent Street, Woolloongabba, Queensland, 4102, Australia.
| |
Collapse
|
9
|
van Eijck MM, Sprengers MO, Oldenbeuving AW, de Vries J, Schoonman GG, Roks G. The use of the PSH-AM in patients with diffuse axonal injury and autonomic dysregulation: A cohort study and review. J Crit Care 2019; 49:110-117. [DOI: 10.1016/j.jcrc.2018.10.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/17/2018] [Accepted: 10/25/2018] [Indexed: 01/19/2023]
|
10
|
Abstract
Traumatic brain injury (TBI) is the cause for long-term disability in more than 3 million patients in the US alone, with chronic pain being the most frequently reported complain. To date, predisposing mechanisms for chronic pain in TBI patients are largely unknown. Psychological disorders, including post-traumatic stress disorder, depression and anxiety following TBI are commonly reported comorbidities to post-traumatic pain. Long term consequences can be debilitating and affect quality of life even when the injury is mild. In this review, we present the most commonly reported chronic pain conditions across the spectrum of severity of TBI, mainly focusing on mild TBI. We discuss chronic post- traumatic headaches, widespread pain as well as post-traumatic central pain. We discuss pain in the context of injury severity and military versus civilian populations. We are only starting to understand the biological mechanisms behind post-traumatic pain and associated psychological distress following TBI, with genetic, biochemical and imaging studies pointing to the dopaminergic, neurotrophic factors and the role of Apolipoprotein. Physiological and neurological mechanisms are proposed to partially explain this interaction between post-traumatic pain and psychological distress. Nevertheless, the evidence for the role of structural brain damage remains incomplete and to a large extent debatable, as it is still difficult to establish clear causality between brain trauma and chronic pain. Finally, general aspects of management of chronic pain post-TBI are addressed.
Collapse
|
11
|
Huang H, Cheng WX, Hu YP, Chen JH, Zheng ZT, Zhang P. Relationship between heterotopic ossification and traumatic brain injury: Why severe traumatic brain injury increases the risk of heterotopic ossification. J Orthop Translat 2017; 12:16-25. [PMID: 29662775 PMCID: PMC5866497 DOI: 10.1016/j.jot.2017.10.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/12/2017] [Accepted: 10/18/2017] [Indexed: 01/01/2023] Open
Abstract
Heterotopic ossification (HO) is a pathological phenomenon in which ectopic lamellar bone forms in soft tissues. HO involves many predisposing factors, including congenital and postnatal factors. Postnatal HO is usually induced by fracture, burn, neurological damage (brain injury and spinal cord injury) and joint replacement. Recent studies have found that patients who suffered from bone fracture combined with severe traumatic brain injury (S-TBI) are at a significantly increased risk for HO occurrence. Thus, considerable research focused on the influence of S-TBI on fracture healing and bone formation, as well as on the changes in various osteogenic factors with S-TBI occurrence. Brain damage promotes bone formation, but the exact mechanisms underlying bone formation and HO after S-TBI remain to be clarified. Hence, this article summarises the findings of previous studies on the relationship between S-TBI and HO and discusses the probable causes and mechanisms of HO caused by S-TBI. The translational potential of this article: A better understanding of the probable causes of traumatic brain injury-induced HO can provide new perspectives and ideas in preventing HO and may support to design more targeted therapies to reduce HO or enhance the bone formation.
Collapse
Affiliation(s)
- Huan Huang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Wen-Xiang Cheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yi-Ping Hu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jian-Hai Chen
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Zheng-Tan Zheng
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China
| | - Peng Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China
| |
Collapse
|
12
|
Bargellesi S, Cavasin L, Scarponi F, De Tanti A, Bonaiuti D, Bartolo M, Boldrini P, Estraneo A. Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay: cross-sectional survey. Clin Rehabil 2017; 32:255-262. [PMID: 28805078 DOI: 10.1177/0269215517723161] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres. DESIGN Multicentre cross-sectional survey. SETTING A total of 48 severe acquired brain injury rehabilitation institutes. PARTICIPANTS Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016. MAIN OUTCOME MEASURE Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion. RESULTS Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications. CONCLUSION Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.
Collapse
Affiliation(s)
- Stefano Bargellesi
- 1 Physical Medicine and Rehabilitation-Severe Brain Injuries Rehabilitation Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Luisa Cavasin
- 2 School of Physical Medicine and Rehabilitation, University of Padova, Padova, Italy
| | - Federico Scarponi
- 3 Severe Brain Injuries Rehabilitation Unit, San Giovanni Battista Hospital, Foligno, Italy
| | - Antonio De Tanti
- 4 Severe Brain Injuries Rehabilitation Unit, Cardinal Ferrari Rehabilitation Centre, Santo Stefano Rehabilitation Institute, Fontanellato, Italy
| | - Donatella Bonaiuti
- 5 Physical Medicine and Rehabilitation Unit, San Gerardo Hospital, Monza, Italy
| | - Michelangelo Bartolo
- 6 Rehabilitation Department, Severe Brain Injuries Rehabilitation Unit, Habilita Institute, Bergamo, Italy
| | - Paolo Boldrini
- 7 Rehabilitation Department, Azienda ULSS 2 and President of Italian Society of Physical Medicine & Rehabilitation (SIMFER), Treviso, Italy
| | - Anna Estraneo
- 8 Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, ICS Maugeri, Telese Terme, Italy
| | | |
Collapse
|
13
|
Reznik JE, Biros E, Lamont AC, Sacher Y, Kibrik O, Milanese S, Gordon S, Galea MP. A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part I: Effects on pain. Brain Inj 2017; 31:526-532. [PMID: 28340308 DOI: 10.1080/02699052.2017.1283059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Neurogenic heterotopic ossification (NHO) is a complication of a neurological injury following traumatic brain injury (TBI) and may be present around major synovial joints. It is often accompanied by severe pain, which may lead to limitation in activities of daily living. Currently, a common intervention for NHO is surgery, which has been reported to carry many additional risks. This study was designed to assess the effect of extracorporeal shock wave therapy (ESWT) on pain in patients with TBI with chronic NHO. METHODS A series of single-case studies (n = 11) was undertaken with patients who had TBI and chronic NHO at the hip or knee. Each patient received four applications of high-energy EWST delivered to the affected joint over 8 weeks. Two-weekly follow-up assessments were carried out, and final assessments were made 3 and 6 months post-intervention. Pain was measured using the Faces Rating Scale, and X-rays were taken at baseline and 6-months post-intervention to physiologically measure the size of the NHO. RESULTS The application of high-energy ESWT was associated with significant overall reduction of pain in patients with TBI and NHO (Tau-0.412, 95% confidence interval -0.672 to -0.159, p = 0.002). CONCLUSIONS ESWT is a novel non-invasive intervention for reducing pain resulting from NHO in patients with TBI.
Collapse
Affiliation(s)
- J E Reznik
- a College of Healthcare Science and Division of Tropical Health and Medicine
| | - E Biros
- b Queensland Research Centre for Peripheral Vascular Disease
| | - A C Lamont
- c College of Medicine and Dentistry, James Cook University , Townsville , QLD , Australia.,d Department of Radiology , The Townsville Hospital , Townsville , QLD , Australia
| | | | - O Kibrik
- f Loewenstein Rehabilitation Center, Sackler Faculty of Medicine , Tel Aviv University , Raanana , Israel
| | - S Milanese
- g Discipline of Physiotherapy , University of South Australia , Adelaide , SA , Australia
| | - S Gordon
- h College of Healthcare Science, James Cook University , Townsville , QLD , Australia.,i School of Health Sciences, Flinders University , Bedford Park , SA , Australia
| | - M P Galea
- j Department of Medicine, Royal Melbourne Hospital , The University of Melbourne , Melbourne , VIC , Australia.,k James Cook University , Townsville , QLD , Australia
| |
Collapse
|
14
|
Reznik JE, Biros E, Sacher Y, Kibrik O, Milanese S, Gordon S, Galea MP. A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function. Brain Inj 2017; 31:533-541. [PMID: 28340312 DOI: 10.1080/02699052.2017.1283060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Neurogenic heterotopic ossification (NHO) occurs as a complication of traumatic brain injury (TBI). Management of clinically significant NHO remains variable. Complications of mature NHO include limitation of mobility. The effect of the extracorporeal shock wave therapy (ESWT) on range of motion at hip and knee, and function in patients with TBI with chronic NHO was investigated. METHODS A series of single-case studies applying ESWT to chronic NHO at the hip or knee of 11 patients with TBI were undertaken at a rehabilitation hospital. Participants received four applications of high-energy EWST delivered to the affected hip or knee over a period of 8 weeks. Two-weekly follow- up assessments were carried out; final assessments were made 3 and 6 months post-intervention. Range of motion (ROM) and Functional Reach (FR) or Modified Functional Reach (MFR) were measured. RESULTS Application of high-energy ESWT was associated with significant improvement in ROM (flexion) of the NHO-affected knee (Tau = 0.833, 95% CI 0.391-1.276, p = 0.002) and significant improvement of FR (Overall Tau 0.486, 95% CI 0.141-0.832, p = 0.006); no significant improvement in hip ROM or MFR. CONCLUSIONS ESWT may improve mobility and balance of patients with TBI who have chronic NHO.
Collapse
Affiliation(s)
- J E Reznik
- a College of Healthcare Science and Division of Tropical Health and Medicine
| | - E Biros
- b Queensland Research Centre for Peripheral Vascular Disease , James Cook University , Townsville , QLD , Australia
| | | | - O Kibrik
- d Loewenstein Rehabilitation Center, Sackler Faculty of Medicine , Tel Aviv University , Raanana , Israel
| | - S Milanese
- e Discipline of Physiotherapy , University of South Australia , Adelaide , SA , Australia
| | - S Gordon
- f College of Healthcare Science, James Cook University , Townsville , QLD , Australia.,g School of Health Sciences, Flinders University , Bedford Park , SA , Australia
| | - M P Galea
- h Department of Medicine, Royal Melbourne Hospital , The University of Melbourne , Melbourne , VIC , Australia.,i College of Healthcare Science and Division of Tropical Health and Medicine, James Cook University , Townsville , QLD , Australia
| |
Collapse
|
15
|
Chen S, Liu J, Cai J, Zheng W, Li Z, Chen W, Fan C. Results and outcome predictors after open release of complete ankylosis of the elbow caused by heterotopic ossification. INTERNATIONAL ORTHOPAEDICS 2017; 41:1627-1632. [DOI: 10.1007/s00264-016-3395-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/27/2016] [Indexed: 10/20/2022]
|
16
|
Veltman ES, Lindenhovius ALC, Kloen P. Improvements in elbow motion after resection of heterotopic bone: a systematic review. Strategies Trauma Limb Reconstr 2014; 9:65-71. [PMID: 24934800 PMCID: PMC4122684 DOI: 10.1007/s11751-014-0192-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 06/04/2014] [Indexed: 10/31/2022] Open
Abstract
Complex elbow trauma, severe burn, or a closed head injury render patients at risk for developing heterotopic ossification around the elbow. When heterotopic ossification restricts elbow motion, some patients request surgical resection. We performed a systematic review of the literature to analyze improvement in elbow motion after resection of heterotopic ossification around the elbow. We found that, on average, etiology had little impact on outcome after resection of heterotopic ossification. Resection of heterotopic bone generally leads to improvement of elbow function.
Collapse
Affiliation(s)
- Ewout S Veltman
- Department of Orthopedic Surgery, Secretariaat Orthopedie, G4-221, Academic Medical Center Amsterdam, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
| | | | | |
Collapse
|
17
|
Reznik JE, Milanese S, Golledge J, Biros E, Gordon S, Galea MP. Extracorporeal shock wave therapy as a treatment for heterotopic ossification. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x13y.0000000084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
18
|
Yu H, Watt H, Mohan S. The negative impact of traumatic brain injury (TBI) on bone in a mouse model. Brain Inj 2013; 28:244-51. [PMID: 24295038 DOI: 10.3109/02699052.2013.859735] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION While it is well established that the brain produces hypothalamic hormones and neuropeptides that influence skeletal metabolism, the impact of traumatic brain injury (TBI) on bone is unknown. Based on the recognition from clinical studies that there is an association between TBI and long-term hypothalamic pituitary dysfunction, it was hypothesized that TBI exerts a negative impact on skeletal growth and maintenance. METHODS To test the hypothesis, this study employed a repetitive weight drop model for TBI. Four impacts were applied for four consecutive days on 5-week old female C57BL/6 J mice. Bone measurements were taken 2 weeks after the first impact. RESULTS Bone mineral content (BMC), bone area (B area) and bone mineral density (BMD) in the total body were reduced by 14.5%, 9.8% and 5.2%, respectively, in the impacted vs. control mice. There was a 17.1% reduction in total volumetric BMD (vBMD) and a 4.0% reduction in material vBMD in cortical bone. In trabecular bone, there was a 44.0% reduction in BV/TV. Although there was no change in the cross-sectional bone size, the tibial growth plate and the tibia itself were shortened. CONCLUSION The repetitive animal TBI model produced an immediate, strong negative impact on bone mass acquisition in young mice.
Collapse
Affiliation(s)
- Hongrun Yu
- Musculoskeletal Disease Center, Jerry L. Pettis Memorial VA Medical Center , Loma Linda, CA , USA and
| | | | | |
Collapse
|
19
|
Dizdar D, Tiftik T, Kara M, Tunç H, Ersöz M, Akkuş S. Risk factors for developing heterotopic ossification in patients with traumatic brain injury. Brain Inj 2013; 27:807-11. [DOI: 10.3109/02699052.2013.775490] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|