HO prophylaxis

[xrt123]

Whats the youngest patient you would recommend HO ppx with xrt for? Also does the fact they can not consent due to intubation effect your recs?

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[seper]

I've treated one teenager after bad skiing incident, paralysis... Gotta have consent from parents.

 

[Haybrant]

What do you guys treat for this? Dose?

 

[fiji128]

I would guess that 7 Gy in one fraction is the most commonly used dose. Remember that timing is <4 hours pre-operatively (never actually seen that) or <72 hours post-operatively (all the orthos seem to want this done <24 hours in my experience). Someone posted an excellent review article on benign radiation treatment a few months back in this forum. I am sure it covers this topic.

 

[medgator]

I would guess that 7 Gy in one fraction is the most commonly used dose. Remember that timing is <4 hours pre-operatively (never actually seen that) or <72 hours post-operatively (all the orthos seem to want this done <24 hours in my experience). Someone posted an excellent review article on benign radiation treatment a few months back in this forum. I am sure it covers this topic.

I thought it was <24 pre or post op. We preferred pre, much easier on pt and staff

 

[Krukenberg]

I thought it was <24 pre or post op. We preferred pre, much easier on pt and staff

Kind of risky, no? You can never be 100% sure the operation will happen.


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[medgator]

Kind of risky, no? You can never be 100% sure the operation will happen.


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Usually it's the orthopod sending the pt literally a couple of days before surgery, so it wasn't an issue. Sometimes it was the day before which wasn't fun

 

[Mandelin Rain]

Being located off site, we treat pre-op. See them the week before. Day of, we open a little early to get the guy done by 7 AM. He then drives 10 minutes straight to the hospital for surgery.

It's worked well. Less frustrating than dealing with a narcotized guy in a hip immobilizer and an ambulance transfer. Though there is that chance that the surgery could be cancelled that day for whatever extenuating reason. Knock on wood, it hasn't happened. We do 7 Gy x 1.

Pre-op also allows for appropriate counseling of the age type issues mentioned in OP. Have to at least discuss fertility/second malignancy concerns.

I think the youngest I ever did was 30's, in teens I've generally recommended indomethacin.

 

[BobbyHeenan]

I too try to treat preop (data suggests within 4 hours most ideal). Not always possible though.

Sometimes the ortho's push back about indomethicin recommendations. Some of their literature, especially for multiple site trauma, suggests non-union issues with high dose NSAIDS, so they prefer XRT.

 

[thesauce]

We tend to only see the traumatic acetabular fractures, so we don't often have the luxury of preop