DISODIUM ETIDRONATE - ITS ROLE IN PREVENTING HETEROTOPIC OSSIFICATION IN SEVERE HEAD-INJURY

Abstract

Heterotopic ossification (HO) occurs in up to 75% of patients who survive severe head injury and is a major factor in prolonging their rehabilitation. Prevention of HO has not been emphasized in acute care management of patients with head injury. But with spinal cord injuries and total hip arthoroplasty, HO has been prevented by use of disodium etidronate (EHDP). Incidence and severity of HO was compared in 10 patients with severe head injury who were treated with EHDP and 10 matched controls without drug treatment. Patients selected for EHDP treatment were consecutive admissions who had Glasgow Coma Scores (GCS) less than 9. Treatment was begun within 2-7 days of injury with 20 mg/kg per day via nasogastric tube and was discontinued if the patient awakened within 2 wk (low risk of HO). After 3 mo. EHDP was given orally at 10 mg/kg per day for an additional 3 mo. Ten patients completed the treatment regime and were compared to 10 patients with similar injuries. Of the 10 patients treated with EHDP, 2 developed HO, while clinically significant HO was found in 7 of the 10 nontreated patients (.chi.2 = P < 0.025). This finding could not be explained on the basis of differences in the 2 groups; the groups were alike in age, sex, length of coma, extracranial fracture, spasticity, type of head injury and injury severity (GCS). HO may be prevented by early use of EHDP. Results warrant further clinical trials.