Heterotopic bone formation in the patient with burn injuries. A retrospective assessment of contributing factors and methods of investigation

The incidence of heterotopic bone formation in seven of 25 patients with burn injuries who required endotracheal intubation and ventilation for smoke inhalation injury was believed to be unacceptably high. Factors in the affected patients distinguishing them from those unaffected were sought. Total protein levels were found to be higher in the affected group. This may correlate with the calciuretic response to protein loading reported previously. Of the affected patients, four demonstrated extreme agitation and resisted physiotherapy. Only one of the 18 nonaffected patients was equally agitated and resistant (p less than 0.05). The additional joint trauma sustained by the affected patients may contribute to the development of heterotopic bone. In bone scans in 18 consecutive patients deemed to be at risk, all showed increased radioactivity at multiple joints. Only seven patients developed heterotopic bone. Bone scans are not sufficiently specific to be used as a diagnostic tool in detecting heterotopic bone.