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Ted Melcer, PhD; Brian Belnap, DO; G . Jay Walker, BA; Paula Konoske, PhD; Michael Galarneau, MS

Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients. Ted Melcer, PhD; Brian Belnap, DO; G . Jay Walker, BA; Paula Konoske, PhD; Michael Galarneau, MS.

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Ted Melcer, PhD; Brian Belnap, DO; G . Jay Walker, BA; Paula Konoske, PhD; Michael Galarneau, MS

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  1. Heterotopic ossification in combat amputees from Afghanistan and Iraq wars: Five case histories and results from a small series of patients Ted Melcer, PhD; Brian Belnap, DO; G . Jay Walker, BA; Paula Konoske, PhD; Michael Galarneau, MS

  2. Heterotopic Ossification (HO)Definition: Excess bone growth in soft tissues. Study Aim • Describe radiographic and symptomatic evidence of HO in 27 OIF/OEF (Iraq/Afghanistan) combat amputees. Relevance • HO frequently occurs in residual limbs of combat amputees. • Resulting skin breakdown and pain can interfere with prosthetic use and walking, thereby delaying rehabilitation.

  3. Case Studies: Radiographs HO after elective, delayed transtibial amputation. Prosthetic adjustments were unsuccessful, and surgical excision reduced pain and restored function. Moderate HO intransfemoralamputee caused pain, which was managed by prosthetic adjustments. HO benefited prosthetic suspension in this case. Moderate HO in transfemoral amputee caused no pain or interference with prosthetic use.

  4. Radiographic and Symptomatic Evidence of HO (25 limbs) 5 of the 15 patients who showed HO in their radiographs did not report symptoms

  5. Conclusions HO impact on pain, prosthetic use, and walking • Depends on location of HO relative to pressure-sensitive and pressure-tolerant areas of residual limb. • 1/3 of patients who had radiographic evidence of HO reported no symptoms. • In rare cases, HO might benefit prosthetic fitting (suspension). Prophylactic medications • Medications such as nonsteroidal, anti-inflammatory agents have been used as HO prophylaxis in combat amputees without other significant injuries. However, evidence of their effectiveness in combat amputees is inconclusive. Surgical excision • Considered a final option after prosthetic adjustments; must weigh risks and benefits of additional surgery.

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