Physical and rehabilitation medicine management of heterotopic ossification in brain injury

Abstract

The aim of this work is to determine the epidemiological and characteristics and the therapeutic modalities of heterotopic ossification in brain injury. Retrospective study conducted between January 2010 and January 2016, including patients hospitalized for management of sequelae of an isolated head injury or associated with multiple trauma, and in whom the diagnosis of of heterotopic ossification (HO) was increased. A review of epidemiological data (including age, sex, occupation, type of neurological injury, discovering circumstances of HO), clinical data, the therapeutic choice and evolutivity. Twenty-nine patients with HO were included in the study, 22 adults and 7 children. A male predominance was noted with a sex ratio of 3/1. Mean Glasgow Outcome scale following the trauma was 6/15. Muscle retractions were noted in 23 patients, mainly affecting the upper limb muscles of the wrist and hands and leg sural triceps. Forty-three HO were found in 29 patients. The main locations of HO were respectively hips, knees and elbows. All patients had rehabilitation and working life skills adapted to the evolutionary stage of the brain trauma. Drug treatment included non-steroidal anti-inflammatory and analgesic. HO resection was performed in 15 patients having significant functional limitation or a painful nerve compression. Six adults were able to resume their old job and three children were able to resume normal schooling. The recruitment of our patients has been among the severe trauma patients explaining the high incidence of heterotopic ossifications (HO). The hip is the location most frequently found which is comparable to the literature data. This work highlights the importance of early detection and multidisciplinary management of HO in brain injury patients. These HO will determine the functional prognosis and the social and professional reintegration of the brain injury patient.