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Potential Risk Factors for Developing Heterotopic Ossification in Patients With Severe Traumatic Brain Injury

van Kampen, P.J. MD; Martina, J.D. MD; Vos, P.E. MD, PhD; Hoedemaekers, C.W.E. MD, PhD; Hendricks, H.T. MD, PhD

The Journal of Head Trauma Rehabilitation: September/October 2011 - Volume 26 - Issue 5 - p 384–391
doi: 10.1097/HTR.0b013e3181f78a59
Original Articles

Background: Heterotopic ossification (HO) is a frequent complication after traumatic brain injury (TBI). The current preliminary study is intended to provide additional data on the potential roles that brain injury severity, concomitant orthopaedic trauma, and specific intensive care complicating events may play in the prediction of HO in patients who have sustained severe TBI.

Methods: A prospective cohort study in patients with severe TBI.

Results: Ninety-seven of the 176 patients were eligible for follow-up; 13 patients (13%) developed 19 clinically relevant HOs at 1 or more sites. Univariate analysis indicated that patients with HO remained in coma longer (P < .001) and were ventilated during a longer period (P = .002). Autonomic dysregulation (relative risk = 6.11, 95% confidence interval: 2.53–14.76) and surgically treated extremity fractures (relative risk = 5.02, 95% confidence interval: 1.68–15.04) also showed significant associations with the development of HO.

Conclusion: Prolonged coma duration and mechanical ventilation, coexistent surgically treated bone fractures and clinical signs of autonomic dysregulation should be given further consideration as potential risk factors for developing clinically relevant HO. Larger-scale studies are needed to develop a valid risk profile that takes into account the interrelationships between variables.

Rehabilitation Centre Groot Klimmendaal, Arnhem (Drs van Kampen and Martina); and Institute of Neurology (Dr Vos), Department of Intensive Care Medicine (Dr Hoedemaekers), and Department of Rehabilitation Medicine (Dr Hendricks), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.

Corresponding Author: H.T. Hendricks, MD, PhD, Department of Rehabilitation Medicine, Radboud University Nijmegen Medical Centre, Post Box 9011, 6500 HB Nijmegen, the Netherlands (

Conflict of Interest: Dr Vos serves on a scientific advisory board and received funding for travel and speaker honoraria from Ever Neuro Pharma, serves as a member of the editorial advisory board of The European Journal of Neurology, and has received honoraria for lectures or educational activities not funded by the industry.

The remaining authors declare no conflict of interest

© 2011 Lippincott Williams & Wilkins, Inc.