Abstract
BackgroundHeterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO. The following factors are presumed to place a patient at higher risk: 60 years of age or older, male, previous HO, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, prior hip surgery, and surgical risk factors.Case presentationA 33-year-old male, involved in a motor vehicle crash, sustained an irreducible acetabulum fracture/dislocation, displaced proximal humerus fracture, and an impacted pilon fracture. During the time of injury, he was intoxicated from inhaling the aerosol propellant used in "dust spray" cans (1,1-difluoroethane, C2H4F2). Radiographs identified rapid pathologic bone formation about the proximal humeral metaphysis, proximal femur, elbow, and soft tissue several months following the initial injury.DiscussionThe patient did not have any genetic disorders that could have attributed to the bone formation but had some risk factors (male, fracture with dislocation). Surgically, the recommended precautions were followed to decrease the chance of HO. Although the patient did not have neurogenic injuries, the difluoroethane in dusting spray can cause damage to the central nervous system. Signals may have been mixed causing the patient's body to produce bone instead of tissue to strengthen the injured area.ConclusionWhat is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4–6 week window in which HO starts to appear. The authors are not certain as to the cause of this rapid formation but suspect that the patient's continued abuse of inhaled aerosol propellants may be the culprit.
Highlights
Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum
What is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4–6 week window in which HO starts to appear
Individuals over the age of 60, males, patients with previous HO bone, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), prior hip surgery, and surgical risk factors place the patient at a higher risk for the formation of HO [1,2]
Summary
To rule out any signs or factors that may have contributed to HO in the patient, we reviewed pertinent medical, social and surgical history. The patient does not have a history of any of the contributing genetic disorders (fibrodysplasia ossificans progressiva, progressive osseous heteroplasia, or Albright's hereditary osteodystrophy). The pathologic bone formation was not evident in any radiographs until 6 months following the initial injuries and 3 months after his resection surgery. This is long outside the 4–6 week window in which HO starts to appear on plain radiographs [3]
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