To Determine the Prevalence of Heterotopic Ossification around Trochanter and its Relation to Complexity of Diaphyseal Femur Fracture after Reamed Intramedullary Interlock Nailing

ABSTRACT

Introduction: Pathological bone formation into softtissues around the hip is known as heterotopic ossification.Osteogenic debris deposited while reaming the femur ispostulated mechanism.This pathological bone formation maybe linked to aggressive tissue handling during operation.The complex femoral diaphyseal fractures are difficult toreduce and this increases the probability of aggressive tissuehandling by operating surgeon. So we postulated that complexfractures of femoral diaphysis may possess an increased riskof heterotopic ossification.Material and Methods: Present retrospective study was doneon 45 patients in whom intramedullary interlocking nail wasdone during the period of 2015 to 2017 at Rohilkhand MedicalCollege. All fractures were diaphysial in location. All surgerieswere done by single orthopaedic surgeon. No preventivemeasures for heterotopic ossification were given. Evidence ofheterotopic ossification around trochanter and their relationwith the type of fracture were noted and classified accordingto Brumback Classification.Results: We found no ossification in 51% of cases. Mild grade-1and 2 ossifications were seen in only 36% and 11% patientsrespectively. Maximum number of grade-2 ossifications (4 outof 5) were seen in patients with comminuted fracture group.Grade-3 ossification was seen in only 1 patient of our sampleand that was comminuted fracture. We have not encounteredany grade-4 ossification.Conclusion: The overall incidence of heterotopic ossificationin our study sample was 49%. More severe grade ossifications(grade-2 and 3) have more predilection towards comminutedfracture variant.