Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk
The British Journal of Radiology
The British Institute of Radiology
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Burnet, N., Nasr, P., Yip, G., Scaife, J., House, T., Thomas, S., Harris, F., et al. (2014). Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk. The British Journal of Radiology, 87 https://doi.org/10.1259/bjr.20140398
Objective Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. Methods Thirty four patients underwent reconstruction of acetabular fractures through a posterior approach, followed by 8 Gy single fraction. Mean age was 44 years. Mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared to a method (Trott & Kemprad) specifically for estimating RT risk for benign disease. These were compared to risks associated with indometacin and no prophylaxis. Results Twenty eight patients (82%) developed no HO; 6 developed Brooker Class I, none developed Class II - IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1-in-1000 to 1-in-10,000; the Trott & Kemprad method suggests 1-in-3000. For younger patients this may rise to 1-in-2000; for elderly patients it may fall to 1-in-6000. Risk of death from gastric bleeding or perforation from indometacin is 1-in-180 to 1-in-900, in older patients. Without prophylaxis risk of death from re-operation to remove HO is 1-in-4000 to 1-in-30,000. Conclusions These results are encouraging, consistent with much larger series, and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. Advances in knowledge Risk from RT prophylaxis is small, it is safer than indometacin, and substantially overlaps with the range for no prophylaxis.
NGB is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre. JES is supported by Cancer Research UK through the Cambridge Cancer Centre.
External DOI: https://doi.org/10.1259/bjr.20140398
This record's URL: https://www.repository.cam.ac.uk/handle/1810/245900