Heterotopic Ossification following Suprapatellar Intramedullary Nailing

Abstract

Introduction: Tibial shaft fractures are common fractures seen in trauma and orthopedic practice today. The majority of these fractures are treated with intramedullary nailing (IMN) which is rapidly becoming a gold standard. The procedure itself is performed by either a suprapatellar approach or infrapatellar approach. Suprapatellar approach is gaining popularity due to relative ease of insertion, decreased associated risk of anterior knee pain, and more accurate reduction. We report a case of heterotopic ossification noted in the knee following IMN of tibia performed using a suprapatellar approach.

Case report: A 27-year-old male, having sustained a left, Gustilo IIIB tibial shaft fracture following a motor vehicle accident, underwent a reamed intramedullary nail fixation performed through a suprapatellar approach. Two months later, he presented with intra-articular heterotopic ossification which was limiting his knee movement. He then underwent arthroscopic removal of the bony fragments which resolved his symptoms.

Conclusion: An extensive search of literature did not yield any reported incidence of heterotopic ossification associated with IMN performed through a suprapatellar approach. We present this case report to raise awareness that although IMN through a suprapatellar approach is a safe approach, it does have associated risk of heterotopic ossification which needs to be included in the consent process.

Keywords: Heterotopic ossification; Intramedullary nailing; Suprapatellar approach; Tibial shaft fracture.

Figure 1

Lateral radiograph showing ossified fragment before arthroscopy.

Figure 2

a: Arthroscopic image heterotopic bone. b: Arthroscopic image heterotopic bone impinging in extension.

Figure 3

Radiograph following removal of fragment and progression to union.