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Prophylaxis of Heterotopic Ossification in Patients Sedated after Polytrauma : Medical and Ethical Considerations = Prophylaxe heterotoper Ossifikationen bei sedierten Patienten nach Polytrauma. Medizinische und ethische Überlegungen

Oertel, Susanne ; Schneider, Uwe ; Keel, Marius ; Lütolf, Urs ; Bosshard, Georg

In: Strahlentherapie und Onkologie, 2008, vol. 184, no. 4, p. 212-217

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    Title
    • Prophylaxis of Heterotopic Ossification in Patients Sedated after Polytrauma
      Medical and Ethical Considerations
    Translated Title ()
    • Prophylaxe heterotoper Ossifikationen bei sedierten Patienten nach Polytrauma. Medizinische und ethische Überlegungen
    Author
    • Oertel, Susanne. Department of Radiooncology, Zurich University Hospital, Zurich, Switzerland
    • Schneider, Uwe. Department of Radiooncology, Triemli Hospital, Zurich, Switzerland
    • Keel, Marius. Department of Traumatology, Zurich University Hospital, Zurich, Switzerland
    • Lütolf, Urs. Department of Radiooncology, Zurich University Hospital, Zurich, Switzerland
    • Bosshard, Georg. Institute of Biomedical Ethics and Department of Clinical Ethics, Zurich University Hospital, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:314285
    Summary
    Background and Purpose:: Heterotopic ossification (HO) often follows acetabular fractures after multitrauma. Irradiation is a mean for prophylaxis. We established a standard procedure in our hospital for patients under sedation, when obtaining informed consent for HO prophylaxis is impossible. Patients and Methods:: We reviewed current scientific evidence, calculated the risks of radiation and presented the ethical and legal framework. The subject was scrutinised by an interdisciplinary panel. Results:: Irradiation is the most effective means for prophylaxis and has few adverse effects in adult patients with fractures of the acetabulum. The lifetime risk of radiation-induced cancer or infertility are insignificant. Conclusions:: Informed consent for irradiation should be obtained before operation whenever possible. When this cannot be done prophylaxis can be postponed for a maximum of 3 days in order to obtain consent. If the patient is not able to communicate within this period, prophylactic irradiation should be given after consulting the relatives. The patient must be informed as soon as possible