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Evidence comparing external beam radiation (XRT) and nonsteroidal anti-inflammatory drugs (NSAIDs) for HO prophylaxis remains conflicting. This study evaluated changes in XRT utilization during the COVID-19 pandemic and compared the efficacy of XRT versus NSAIDs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted of 180 patients undergoing open acetabular fracture fixation at a level 1 trauma center from 2018 to 2021. High-risk patients received XRT or indomethacin if XRT was declined. Outcomes included prophylaxis method, severe (Brooker 3 or 4) HO, and HO resection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      XRT utilization decreased significantly during the pandemic (74.3% vs. 28.0%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). While severe HO rates remained similar (7.1% with XRT and 9.9% with NSAIDs) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.498), the only three HO resections were in the NSAIDs cohort.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite reduced XRT use during COVID-19, HO outcomes were unchanged, suggesting both XRT and NSAIDs are effective prophylaxis options.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-026-04764-4","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T07:48:43Z","timestamp":1779436123000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reduction in utilization of radiation for heterotopic ossification prophylaxis following acetabular surgery during the COVID-19 pandemic"],"prefix":"10.1007","volume":"36","author":[{"given":"Johnathan W.","family":"Riley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac J.","family":"Spears III","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rowdy C.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian C.","family":"Clark II","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cole","family":"Debevec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josny","family":"Thimothee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Weathersby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka V.","family":"Nehete","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter N.","family":"Mittwede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick F.","family":"Bergin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"issue":"2","key":"4764_CR1","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1007\/s11999-008-0532-9","volume":"467","author":"TJ Blokhuis","year":"2009","unstructured":"Blokhuis TJ, Frolke JP (2009) Is radiation superior to indomethacin to prevent heterotopic ossification in acetabular fractures? a systematic review. 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