Utility of radiation in the prevention of heterotopic ossification following repair of traumatic acetabular fracture

Purpose: Heterotopic ossification (HO) is a common problem following surgic al repair of traumatic acetabular fracture (TAF), potentially causing sever e pain and decreased range of motion. This report analyzes the role of radi ation therapy for prevention of HO in TAP. Methods and Materials: The charts of all patients who received RT to the hi p following TAP repair between July 1988 and January 1998 were reviewed. Si xty-six patients were identified. RT was given in 5 fractions of 2 Gy in 45 patients, 1 fraction of 8 Gy in 17 patients, and other doses in 4 patients . Treatment fields encompassed periacetabular tissues at highest risk for H O, Time to RT was less than or equal to 24 hours for 46 patients. Results: Radiographic follow-up at least 6 months following RT was availabl e in 47/66 (71%) patients to permit Brooker classification, revealing 6 cas es (13%) of Grade III HO, compared to historical incidence in this populati on of 50%, No Grade IV HO was found. Mean follow-up was 18 months. Four of the Grade III patients had received 10 Gy/5 fractions, and 2 received 8 Gy/ 1 fraction. Postoperative wound infection occurred in 6 patients, and osteo necrosis of the femoral head was found in 13. Conclusions: RT following surgical repair of TAF provides effective prophyl axis against formation of clinically significant HO. We recommend a single fraction of 7-8 Gy within 24 hours of surgery to prevent HO formation and m inimize patient discomfort. (C) 1999 Elsevier Science Inc.