Poster 13: Early surgery for heterotopic ossification in traumatic brain injury with 10-year follow-up: a report of 2 cases

Abstract

Setting: Freestanding rehabilitation hospital. Patients: A 54-year-old man and a 48-year-old woman. Case Description: We studied the cases of 2 patients who were admitted in 1987 (patient A) and 1990 (patient B) to our institution for traumatic brain injury rehabilitation. Both patients had heterotopic ossification (HO) of the hip. Patient B could achieve a maximum hip flexion of 20° to 30° before surgery with intensive physical therapy (PT) during inpatient rehabilitation. Patient A’s right hip range of motion (ROM) was 65° of flexion during inpatient rehabilitation. Over next 6 to 8 months, during outpatient treatment, patient A’s ROM decreased to 50° of flexion at hip. Both underwent early surgical excision of immature HO (patient B at 7mo; patient A at 12mo after injury) secondary to severe limitation in ROM at the hip leading to pain and dysfunction. Assessment/Results: After resection of HO, patient A’s right hip ROM increased to 90° and patient B’s left hip ROM increased to 55°. With intensive PT over the next 3 months, hip flexion improved to 85° for patient B. Both patients were independent community ambulators with a straight cane at the time of discharge from outpatient rehabilitation. Discussion: At 10-year follow-up, functional and ROM gains were maintained in both patients without any recurrence after surgery. Conclusions: Early surgical intervention is beneficial in patients with HO, which causes severe limitation in ROM and functional loss. The benefits far outweigh the risks of recurrence and are long lasting.