Pediatric Heterotopic Ossification: A Comprehensive Review

Abstract

Purpose of review: The purpose of this review is to provide a comprehensive analysis of heterotopic ossification (HO) in pediatric patients, including an in-depth examination of the risk factors associated with this condition, current prophylactic measures, and available management strategies.

Recent findings: HO is a medical disorder in which bone tissue inexplicably develops in soft tissues such as muscles and tendons. It involves the formation of mature, lamellar bone in extra-skeletal soft tissue, and its formation is influenced by oxygen tension, pH, the availability of micronutrients, and mechanical stimulation. HO has many cellular origins, with the most common theory being multipotent cells in local tissue. The diagnosis of HO is typically made based on exam, radiographs, and CT. Management includes both prophylactic nonsurgical options and surgical resection for severe or recalcitrant cases. The review highlights the incidence, risk factors, and management strategies associated with HO in pediatric patients. HO is a rare condition in children, with severe neurologic injury being the most common cause. Pediatric patients most commonly develop HO following severe neurologic injury, followed by trauma and surgery. Current prophylactic measures, include nonsteroidal anti-inflammatory drugs and radiation therapy though limited literature on their use in the pediatric population exists. For recalcitrant symptomatic cases, wide surgical resection can be considered but has a higher risk profile and associated morbidity. This review highlights the need for further pediatric specific research to inform guidelines and management strategies for this debilitating condition.

Keywords: Pediatric heterotopic ossification; Pediatric heterotopic ossification management; Pediatric heterotopic ossification prophylaxis; Pediatric heterotopic ossification risk factors.

Fig. 1

A Computed tomography 3D reconstructions and B intra-operative fluoroscopy demonstrating heterotopic ossification of the right femur and ischium in a 16-year male who suffered severe traumatic brain injury from a motor vehicle accident. C Intra-operative fluoroscopy demonstrating resection of the prior ischial heterotopic ossification

Fig. 2

A AP pelvis radiographs demonstrating left hip heterotopic ossification in a 17-year-old female who 4 months prior had been involved in a motor vehicle accident suffering severe traumatic brain injury and B AP pelvis radiographs taken of the same patient in Fig. 2a after operative heterotopic ossification wide resection