Heterotopic ossification in orthopaedic trauma

Abstract

Heterotopic ossification (HO) can be defined as the pathologic formation of bone in extraskeletal tissues. There has been a substantial amount of recent research on the pathophysiology, prophylaxis, and treatment of HO and traumatic conditions associated with the development of HO. This research has advanced our understanding of this disease and helped to clarify evidence-based approaches to both the prophylaxis and treatment of HO. This article reviews the literature on these topics with a focus on their application in orthopaedic trauma.

Figures 1A and 1B

Three dimensional computed tomography scan reconstructions of the right hip of a 29 year-old male patient who sustained an isolated head injury and required surgical treatment of an epidural hematoma with prolonged coma and intensive care unit stay post-operatively. The patient developed heterotopic ossification in his hip that significantly limited his ability to sit and ambulate. The images demonstrate Brooker Class IV HO formation in the anterior aspect of his hip.

Figures 2 A, B, and C

The same patient from Figure 1 underwent surgical excision of his HO via a modified Smith-Petersen approach followed by single dose radiation therapy 24 hours post-operatively. Images A and B demonstrate pre and post-operative maximum hip flexion. Image C shows the amount of bone removed from the hip.