heterotopic ossification case

7/27/2019 Heterotopic Ossification Case

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Case Report

Dr Sethu.S

Asssistant ProfessorGovt TDMC Alappzha


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41 year old male presented with h/o

RTA,

known PPRP Rt, but able to walk and drivescooter, addicted to alcohol

came to casualty on 27/05/2013


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Initial Xray


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Initial Xrays


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Intial xrays


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Injuries summarised

1.Fracture dislocation Lt hip with intraarticular

fragment

2.Brachial plexus neuropraxia Lt

3.Foot drop Lt

4.Alcohol withdrawal


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As expected, after closed

manipulative reduction wefound that it is unstable


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Treatment

Options?


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We did an open reduction and

fixed with cancellous screws

countersunk on 11/6/2013


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Immediate check xray


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X-ray on 22/8/2013


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Review of Literature

Heterotopic ossification usually occurs in

trauma such as fractures and surgical

procedures.

Heterotopic ossification of the hip, is the most

common complication of total hip arthroplasty

(THA). It can occur in as many as 53% of THA

patients


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Etiology

Pluripotential mesenchymal cells differentiate

into osteoblasts, causes heterotopic

ossification

bone morphogenetic protein, is most likely

responsible for the differentiation.

Differentiation occurs within 16 hours after

surgery and peaks at 32 hours.


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Heterotopic ossification starts to appear on

plain Xray 4 to 6 weeks after the trauma,

Typically, the ectopic bone matures 6 to 9months following the trauma


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Brookers Grading scale.

Grade 1. Islands of bone within the soft tissues

about the hip.

Grade 2. Bone spurs in the pelvis or the proximal

end of the femur with at least 1 cm between theopposing bone surfaces.

Grade 3. Bone spurs from the pelvis or proximal

end of the femur with

Grade 4. Radiographic ankylosis.


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Treatment

Surgery The only effective treatment of symptomatic

established heterotopic bone .delayed for 6

months after the initial trauma

Care is taken to avoid injuring the surroundingsoft tissues. Hemostasis is essential to prevent

hematoma formation,

Complete wound lavage and removal of all bonedebris and reamings also are thought to decrease

the risk of heterotopic bone formation.


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Treatment

Radiation

Coventry and Scanlon reported the

prevention of heterotopic ossification with a

fractionated course of radiation

10 Gy in 5 fractions was as effective at

preventing heterotopic ossification

Radiation should be delivered within 72 hours

after surgery


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Treatment

Radiation Side effects

No reports exist of acute or subacute side

effects associated with postoperative

radiation following THA

Increased nonunion rates may occur following

trochanteric osteotomy without shielding


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Treatment

Nonsteroidal Anti-inflammatory Drugs

Indomethacin (25 mg three times a day for 6

weeks) is as effective as radiation

NSAID therapy has side effects, most notably

gastrointestinal ulceration, decreased platelet

aggregation, and renal toxicity

Effect on bony ingrowth, weaker callus

formation


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Diphosphonates have been studied to prevent

heterotopic ossification, but after the drug is

withdrawn, the osteoid becomes mineralized.

Thus, disphosphonates are ineffective in the

prevention of heterotopic ossification


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Thank You

heterotopic ossification case

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