Risk factors for the development of heterotopic ossification in seriously burned adults: A National Institute on Disability, Independent Living and Rehabilitation Research burn model system database analysis

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

Research output: Contribution to journalArticle

25 Scopus citations


BACKGROUND Heterotopic ossification (HO) is a debilitating complication of burn injury; however, incidence and risk factors are poorly understood. In this study, we use a multicenter database of adults with burn injuries to identify and analyze clinical factors that predict HO formation. METHODS Data from six high-volume burn centers, in the Burn Injury Model System Database, were analyzed. Univariate logistic regression models were used for model selection. Cluster-adjusted multivariate logistic regression was then used to evaluate the relationship between clinical and demographic data and the development of HO. RESULTS Of 2,979 patients in the database with information on HO that addressed risk factors for development of HO, 98 (3.5%) 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% total body surface area burn had 11.5 times higher odds of developing HO (p <0.001), and those with arm burns that required skin grafting had 96.4 times higher odds of developing HO (p = 0.04). For each additional time a patient went to the operating room, odds of HO increased by 30% (odds ratio, 1.32; p <0.001), and each additional ventilator day increased odds by 3.5% (odds ratio, 1.035; p <0.001). Joint contracture, inhalation injury, and bone exposure did not significantly increase odds of HO. CONCLUSION Risk factors for HO development include greater than 30% total body surface area burn, 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. LEVEL OF EVIDENCE Prognostic study, level III.



  • burn injury
  • Extremity trauma
  • heterotopic ossification

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this