Model System:


Reference Type:


Accession No.:



Journal of Trauma and Acute Care Surgery

Year, Volume, Issue, Page(s):

, 79, 5, 870-876

Publication Website:


Study identified and analyzed clinical factors that predict heterotopic ossification (HO), the ectopic formation of lamellar bone, in adults with burn injuries. Data were collected from six high-volume burn centers in the Burn Injury Model Systems (BMS) database. The BMS, funded by the National Institute on Disability, Independent Living and Rehabilitation Research, is a program established to research the delivery, demonstration, and evaluation of medical, rehabilitation, and other services designed to meet the needs of individuals with severe burn injuries. Of 2,979 patients in the database with information that addressed risk factors for development of HO, 98 (3.5 percent) developed HO. Of these 98 patients, 97 had arm burns, and 96 had arm grafts. When controlling for age and sex in a multivariate model, patients with greater than 30 percent total body surface area (TBSA) burned had 11.5 times higher odds of developing HO, and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO. For each additional time a patient went to the operating room, odds of HO increased by 30 percent, and each additional ventilator day increased odds by 3.5 percent. Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. Results indicate that risk factors for HO development include greater than 30 percent TBSA burned, arm burns, arm grafts, ventilator days, and number of trips to the operating room. Future studies can use these results to identify highest-risk patients to guide deployment of prophylactic and experimental treatments.


Levi, Benjamin, Jayakumar, Prakash, Giladi, Avi, Jupiter, Jesse B., Ring, David C., Kowalske, Karen, Gibran, Nicole S., Herndon, David, Schneider, Jeffrey C., Ryan, Colleen M.