Link Between Clinical Predictors of Heterotopic Ossification and Histological Analysis in Combat-Injured Service Members.

BACKGROUND: Heterotopic ossification (HO) is a debilitating condition that occurs following traumatic injury and may restrict range of motion and delay rehabilitation. The timing and efficacy of surgical resection have varied widely, and there is a gap in knowledge between clinical predictors of HO recurrence and histological analysis. METHODS: Thirty-three service members seen at Walter Reed National Military Medical Center for symptomatic HO were enrolled in an institutional review board-approved study. Participants took oxytetracycline on four scheduled days prior to HO resection to determine the mineral apposition rate (bone growth rate). RESULTS: Detailed histological analyses included scanning electron microscopy with backscattered electron imaging and light microscopy. Data indicated that the mineral apposition rate of trauma-induced HO was approximately 1.7 µm/day at the time of operative intervention, which was 1.7 times higher than the rate in non-pathological human bone. The mineral apposition rate and postoperative alkaline phosphatase values were demonstrated to be positively and significantly related (ρ = 0.509, p = 0.026, n = 19). When the analysis was limited to patients with no more than a two-year period from injury to excision (thereby removing outliers who had a longer time period than their counterparts) and traumatic brain injury and nonsteroidal anti-inflammatory drugs (known correlates with HO development) were controlled for in the statistical analysis, the mineral apposition rate and recurrence severity were significantly related (ρ = -0.572, p = 0.041, n = 11). CONCLUSIONS: Data demonstrated a link between benchtop research and bedside care, with the mineral apposition rate elevated in patients with HO and correlated with recurrence severity; however, a larger sample size and more clinical factors are needed to refine this model. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Dental needs and perceptions of adult Hispanic migrant farmworkers in Colorado.

To identify oral health needs, 231 adult Hispanic migrant farmworkers participated in an oral interview and dental epidemiologic survey in Colorado in summer 1986. DMFT and CPITN scores and restorative treatment needs were recorded. Overall treatment needs then were calculated. Mean DMFT was 9; 85% had one or more decayed teeth and 66% had one or fewer filled teeth. Analysis of CPITN scores revealed 69% displaying ADA perio cases types I and II, and 28% with ADA case types III and IV. Twenty-two percent of the sample had never received dental care, with another 56% not having received regular care. Barriers to care are cost, time factors, and perceptions of ineffective diagnosis or treatment. Differences by age, sex, language, education, home base, and care-seeking status are presented. Results document the need for increased preventive and treatment services and education for migrant adults.