heterotopic ossification.pptx

8/16/2019 Heterotopic Ossification.pptx

1/17

HETEROTOPIC OSSIFICATION 5-MINUTE ORTHOPAEDIC CONSULT

Presented by:Anggiat Humusor Ulina

C11107226

Advisor :

dr. Hendrian Chaniago

Suervisor:

dr. !arya "ri#o$ S. %". &!' Sine

Orthopedic dan Traumatology

Faculty of Medicine Hasanuddin University

Makassar

2011


2/17

DESCRIPTION

Pathologi( bone )ormation as a(onse*uen(e o) dire(t trauma or

(entral nervous system in+uries ,one )ormed in heterotoi(

lo(ations su(h as mus(le$

sub(utaneous tissues$ or nerves -ost (ommonly o((urs at the

hi$ elbo$ and shoulder +oints


3/17

EPIDEMIOLOGY

/ess (ommon in (hildren than inadults$ and more (ommon in males

than in )emales. n(iden(e:

%((urs in 1020 o) atients ith

(entral nervous system or traumati(in+uries$ ith an average onset o) 2months a)ter in+ury.


4/17

THREE COMMON LOCATIONS OF

HETEROTOPIC OSSIFICATION AROUND

THE HIP JOINT

A: Anterolateral3anteromedial lo(ation4 ,: n)erior and medial lo(ation4and C: /o(ation around the )emoral ne(# and osterior.


5/17

RISK FACTORS

Central nervous system in+ury %steoarthrosis

%steohyte )ormation Surgi(al aroa(h Previous surgi(al ro(edures "ro(hanteri( osteotomy


6/17

ETIOLOGY

"raumati( brain in+ury


7/17

DIAGNOSIS

Signs and SymtomsUne5lained in(rease in ain$ sasti(ity$ or

mus(le guarding

e(reased %-Sti))ness

adiograhi( eviden(e o) e(toi( bone

Physi(al 85am

/imited %- is the most (ommon and earliestsign.

8rythema$ selling$ and signs o) in)lammationalso may be noted.


8/17

TESTS

/abSerum al#aline hoshatase levels are elevated.9alue begins to rise 2 ee#s a)ter in+ury.

maging%n lain radiograhs$ ne bone )ormation may be1st visible at 6 ee#s4 but radiograhs generallyare not (on)irmatory until months.

,one s(ans allo )or earlier dete(tion and sho

intense uta#e.C" may be used )or reoerative lanning and to

sho the ;onal attern: -inerali;ed in the eriheryand lu(ent in the (enter.


9/17

EXTENSIVE

HETEROTOPIC

OSSIFICATION AT THE

MEDIAL ASPECT OF

THE LEFT KNEE


10/17

TESTS

Pathologi(al


11/17

DIFFERENTIAL DIAGNOSIS

Seti( +oint "hrombohlebitis

=eolasm in the so)t tissues


12/17

TREATMENT

>eneral -easures?oint motion is maintained to allo normal )un(tioning.-ost atients are treated su((ess)ully ith

nonoerative measures$ in(luding hysi(al theray$analgesi(s$ and =SAs.


13/17

MEDICATION


14/17

SURGERY

Surgery is indi(ated to restore +oint motion or to(orre(t (ontra(tures in disabled atients$ it should notbe rese(ted earlier than 6 months a)ter in+ury.

85(ision a)ter 2 years in(reases the li#elihood o)

ermanent (ontra(tures. A)ter rese(tion$ atients are treated ith lo doses o)

irradiation &must be delivered ithin 72 hours'.

Some atients ele(t to ta#e =SAs &e.g.$

indometha(in' )or 6 ee#s a)ter rese(tion. astri( intoleran(e revents 10B20 o) atients )rom ta#ing

these medi(ations.


15/17

FOLLOW-UP

PrognosisPrognosis varies$ deending onthe lo(ation o) heterotoi(ossi)i(ation and its (ause.

-ost atients ith nonneurogeni(

heterotoi( ossi)i(ation maintainreasonable )un(tion and do notre*uire surgi(al intervention.


16/17

FOLLOW-UP

Comli(ations/oss o) mobility

An#ylosis Patient -onitoringSerial radiograhs are obtainedat 1 month intervals )or 6months.


17/17

THANK YOU

heterotopic ossification.pptx

Documents