Re: Heterotopic Ossification
Chris L Johnson
Description
Collection
Title:
Re: Heterotopic Ossification
Creator:
Chris L Johnson
Date:
3/1/1998
Text:
On Sat, 28 Feb 1998 01:16:11 EST CPOseattle < <Email Address Redacted> > writes:
>David Cooney, CPO, Monalee Luth, CPO, Keith Vinnecour, CPO and I
>published an article entitled 'The Enhancement of Prosthetics through
>Xeroradiography in, the 1985 edition of Orthotics and Prosthetics,
vol 39, no 1.
Good going! I know quite a few amputees who struggle with fit and pain
and are never asked by their prosthetist or physician to get an x-ray or
Xero to see if the leg itself is the primary problem.
>In it, we reported our findings from routinely using xeroradiographs as
a
>diagnostic tool prior to casting a patient for a prosthesis. In doing
so, we
>discovered that 41% of the residua of the 92 adult transtibial amputees
that we
>studied exhibited heterotopic ossification.
I was, and am, one of those who have gotten, and still have, heterotropic
ossification. In `84, two years post op, I was stopped dead in my tracks
due to some really nasty bone spurs. Had surgery under Dr. Burgess in
Seattle to fix that problem. Later ossification has been slow, and
fortunately not fast enough to form sharp prominences. A recent Xero
showed tibial bone growth being beat posterior in a non-prominent hook by
socket reaction forces, and only a minor amount of growth on the fibular
head toward the tibia. I can feel some popping going on rare occasions
as the growth on the fibular head pops over a feature on the tibia.
I wish I could turn back the clock to have the Ertle technique done, but
that is water under the bridge. I do have a questions, however. Is it
very difficult to preserve the periostium and close the sheath over the
ends of the bone during non-Ertle amputations? Why is periostial closure
not a common thing? Is it wrong to assume that closing the medullar
canal with the periostium (spelling?) would greatly reduce heterotropic
ossification? What I'm really wondering about is this lack of attention
to detail (read: less desire to do more and more difficult work) one of
the primary causes of heterotropic ossification? Seems just whacking a
bone off with no detailed management of the open end would only lead to
trouble and prolong recovery time.
>Yes, start looking at radiographs of your patients and you'll be
amazed.
>
>David Varnau, CPO
Two prosthetists I know, Jan Stakosa of Lansing, MI, and Anthony Layton
of Lawton, OK, consider this standard practice. These two also made my
best prostheses. The connection is firm, I'm sure. Those most prone to
attention to detail are also most likely to do a better job overall. The
same is true of surgeons. My first surgery was done by Dr. I. M.
Hacknwhack. I'm sure he did an amputation or two in school...on
cadavers. Too bad amputation surgery is not regarded as specialty only
performed by true specialists!
I'm no surgeon, but I have always wondered about the validity of closing
the periosteum. Anyone know for sure? If it is a good thing to do, why
is it not common practice? Is material being wasted in ignorance or
negligence?
Chris (CJ) Johnson
Director of Engineering,
College Park Industries, Inc. <URL Redacted>www.college-park.com
(810) 294-7950 (at CPI), (616) 664-4173 (home office)
<Email Address Redacted>
_____________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at <URL Redacted>
Or call Juno at (800) 654-JUNO [654-5866]
>David Cooney, CPO, Monalee Luth, CPO, Keith Vinnecour, CPO and I
>published an article entitled 'The Enhancement of Prosthetics through
>Xeroradiography in, the 1985 edition of Orthotics and Prosthetics,
vol 39, no 1.
Good going! I know quite a few amputees who struggle with fit and pain
and are never asked by their prosthetist or physician to get an x-ray or
Xero to see if the leg itself is the primary problem.
>In it, we reported our findings from routinely using xeroradiographs as
a
>diagnostic tool prior to casting a patient for a prosthesis. In doing
so, we
>discovered that 41% of the residua of the 92 adult transtibial amputees
that we
>studied exhibited heterotopic ossification.
I was, and am, one of those who have gotten, and still have, heterotropic
ossification. In `84, two years post op, I was stopped dead in my tracks
due to some really nasty bone spurs. Had surgery under Dr. Burgess in
Seattle to fix that problem. Later ossification has been slow, and
fortunately not fast enough to form sharp prominences. A recent Xero
showed tibial bone growth being beat posterior in a non-prominent hook by
socket reaction forces, and only a minor amount of growth on the fibular
head toward the tibia. I can feel some popping going on rare occasions
as the growth on the fibular head pops over a feature on the tibia.
I wish I could turn back the clock to have the Ertle technique done, but
that is water under the bridge. I do have a questions, however. Is it
very difficult to preserve the periostium and close the sheath over the
ends of the bone during non-Ertle amputations? Why is periostial closure
not a common thing? Is it wrong to assume that closing the medullar
canal with the periostium (spelling?) would greatly reduce heterotropic
ossification? What I'm really wondering about is this lack of attention
to detail (read: less desire to do more and more difficult work) one of
the primary causes of heterotropic ossification? Seems just whacking a
bone off with no detailed management of the open end would only lead to
trouble and prolong recovery time.
>Yes, start looking at radiographs of your patients and you'll be
amazed.
>
>David Varnau, CPO
Two prosthetists I know, Jan Stakosa of Lansing, MI, and Anthony Layton
of Lawton, OK, consider this standard practice. These two also made my
best prostheses. The connection is firm, I'm sure. Those most prone to
attention to detail are also most likely to do a better job overall. The
same is true of surgeons. My first surgery was done by Dr. I. M.
Hacknwhack. I'm sure he did an amputation or two in school...on
cadavers. Too bad amputation surgery is not regarded as specialty only
performed by true specialists!
I'm no surgeon, but I have always wondered about the validity of closing
the periosteum. Anyone know for sure? If it is a good thing to do, why
is it not common practice? Is material being wasted in ignorance or
negligence?
Chris (CJ) Johnson
Director of Engineering,
College Park Industries, Inc. <URL Redacted>www.college-park.com
(810) 294-7950 (at CPI), (616) 664-4173 (home office)
<Email Address Redacted>
_____________________________________________________________________
You don't need to buy Internet access to use free Internet e-mail.
Get completely free e-mail from Juno at <URL Redacted>
Or call Juno at (800) 654-JUNO [654-5866]
Citation
Chris L Johnson, “Re: Heterotopic Ossification,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 27, 2024, https://library.drfop.org/items/show/210454.
