Eating Is Living: A Case Report of Post-Traumatic Myositis Ossificans in Elbow

Abstract

Introduction: Myositis ossificans (MO) is the most frequent type of heterotopic ossification, occurring in individuals aged 20-40 years within major muscles, and roughly 75% of cases are triggered by trauma. It is most commonly present in locations with a high risk of injury, such as the quadriceps femoris and the arm's flexor muscles, and it is infrequently found in intra-articular sites.

Case report: A 19-year-old male with a history of pain, swelling, and restriction of movements of the right elbow for the last 6 years with a history of difficulty in eating and combing hair with the right hand. History of trauma to his right elbow 6 years ago for which he underwent conservative native treatment with massage. Physical examination found a swelling over the right medial elbow joint of size approximately 7 cm × 6 cm × 3 cm, with no local rise of temperature or tenderness. There was a fixed flexion deformity of 75°. There were no sensory or vascular deficits. Under general anesthesia, through the anterior approach, an irregular bony mass was visualized which was excised. Through a posterior approach, a skin incision was made, subcutaneous tissue dissected, muscles retracted and then a calcified mass visualized over the olecranon process which was excised. The post-operative period was uneventful. Elbow joint mobilization was started from day 2 which showed significant correction of fixed flexion deformity.

Conclusion: It is necessary to rule out non-traumatic MO when a patient exhibits radiologically detectable calcification and complains of a painful lump forming in a muscle. The degree of calcification and mature bone growth varies depending on the stage of the lesion. A biopsy of the lesion can rule out malignant transformation. Surgical excision is required for the management of mature lesions.

Keywords: Elbow; heterotopic ossification; myositis ossificans; post-traumati.

Figure 1

The anterior-posterior (a) and lateral radiographs (b) of the right elbow joint show circumferential calcification with a radiolucent center.

Figure 2

Range of movements being checked preoperatively.

Figure 3

(a) Intra-operative image showing anterior exposure, (b) calcified mass, and (c) posterior exposure.

Figure 4

The anterior-posterior (a) and lateral radiographs (b) of the right elbow joint post-surgery showing complete excision of the mass.

Figure 5

Clinical images at 6 and 12 weeks postoperatively showing elbow range of motion 75–110°, respectively.