Case Of Heterotopic Bone Formation Research Articles

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions.

Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event. Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion? Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics. Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time ( p = 0.028), we found no variables associated with the development of heterotopic bone formation. Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG. Level of Evidence Level II, prognostic study.

Surgical excision of heterotopic ossification associated with anti-N-methyl-d-aspartate receptor encephalitis: A case report.

Introduction and importanceHeterotopic ossification (HO) associated with Anti-N-methyl-d-aspartate (anti-NMDA) receptor encephalitis is rare and the treatment strategy is unclear.Case presentationWe report the case of a 31-year-old female diagnosed with anti-NMDA receptor encephalitis from Osaka General Medical Center, Osaka, JAPAN that developed heterotopic ossification of the knees during prolonged coma. She was unable to walk because of pain and limited range of motion in both knees. Thirty months after the onset of the coma, surgical excision of the heterotopic bone in both knees was performed. The range of motion of both the knees improved markedly and she had no recurrence of heterotopic ossification on a three-year follow-up. Thus, this case can be used as a guide for surgeons with such patients.ConclusionsWe reported a case of heterotopic bone formation in the periarticular region of both bilateral knees in a patient who suffered a 2-month coma following anti-NMDA receptor encephalitis. Surgical excision of the heterotopic bones significantly improved the passive range of motion in both knees. Three years after the operation, the patient had no complaints about her knees, and there was no recurrence of HO.

Risk Factors for Intraarticular Heterotopic Bone Formation in the Temporomandibular Joint in Juvenile Idiopathic Arthritis.

Intraarticular corticosteroid (IAC) injections are often used to treat temporomandibular joint (TMJ) arthritis associated with juvenile idiopathic arthritis (JIA). One potential complication of IA therapy is heterotopic bone formation (HBF). The purpose of our study was to evaluate risk factors for HBF development in children with JIA who received IA therapy for TMJ arthritis. This was a retrospective study of children with JIA who had received ≥ 1 IAC injection into the TMJ. Survival regression analysis was performed to identify risk factors for the development of HBF. There were 238 children included, of whom 33 (14%) developed HBF. No cases of HBF were diagnosed prior to the initial injection. Univariate analysis revealed that the risk factors for development of HBF were the total number of injections received into the TMJ and age at diagnosis of JIA, while the length of time from diagnosis of JIA to the first injection was inversely associated with the risk of HBF formation. The total number of injections was no longer significant following adjusted survival models. Children with HBF had increased physical examination evidence of acute or chronic changes, namely decreased maximal incisal opening and increased likelihood of jaw deviation. HBF within the TMJ is relatively common in patients with JIA receiving IAC injections for TMJ arthritis. Future prospective studies are required to delineate the risks posed by the injections themselves as opposed to the underlying disease activity, as well as to evaluate alternative forms of local therapy to the TMJ.

Heterotopic bone formation in colorectal carcinoma: a case report

Heterotopic bone formation (osseous metaplasia) is rarely seen in the gastrointestinal tract. It usually occurs in the colorectum in association with benign or malignant epithelial tumors, and most often with mucinous adenocarcinoma. The rectum is the most common location of ossification in the gastrointestinal tract. The pathogenesis of the heterotopic ossification is unknown, but it is probably the result of metaplasia of fibroblasts. We present a case of heterotopic bone formation in a primary rectal adenocarcinoma which was observed in a 73-year-old man.

Retrograde Intramedullary Nailing of Femoral Diaphyseal Fractures Caused by Low-velocity Gunshots

The purpose of this study was to evaluate the results of retrograde intramedullary nailing of femoral diaphyseal fractures caused by low-velocity gunshots. Seventy-three patients (68 men and 5 women) with 74 femoral diaphyseal fractures caused by gunshots were treated with reamed, retrograde, statically locked intramedullary nailing. The main outcome measures were fracture union, the need for additional operations, shortening, angular deformity, postoperative knee range of motion, and complication rate. Twenty-nine patients sustained additional injuries. During initial treatment, 18 patients underwent further orthopedic and nonorthopedic elective procedures. Three patients had fasciotomies for compartment syndrome. At follow-up, 3 patients had shortening >10 mm (range, 12-18 mm) and 1 had angulation >10 degrees (13 degrees recurvatum). Four patients underwent surgeries after discharge. Complications included 1 case of heterotopic bone formation, 1 hypertrophic nonunion that went on to union after dynamization, 2 postoperative positive blood cultures, and 1 wound dehiscence. There were no cases of septic arthritis. Our data indicate that there is a low incidence of shortening, angular deformity, complication, and infection rates following treatment of femoral gunshot diaphyseal fractures with a retrograde nail. This study demonstrates that this is an acceptable alternative for the treatment of these injuries.

Heterotopic Bone Formation around a Solid Silicone Chin Implant

Objective: Solid silicone implants have been used successfully with few complications in facial cosmetic surgery since the mid 1960s. The objective of this paper is to report an unusual sequela associated with a solid silicone implant placed for chin augmentation. Methods: Case Report Case Presentation: A 28-year-old Caucasian female presented with complaints of changes in her chin appearance for the past 2 years. She had a mandibular solid silicone implant placed 11 years prior and was happy with the results for 9 years when she began to notice enlargement of the right inferior border which progressed over 2 years prompting a consult at my office. Clinical examination revealed a mild enlargement of the right anterior mandibular border when compared with the left. She had good chin projection and no noticeable mobility of the implant. Radiographic studies revealed a heterotopic bone along the right anterior border of the mandible. Under intravenous sedation and local anesthesia, the inferior mandible and implant were exposed via the previous extra-oral approach. The bone was exposed and removed from the chin implant, which was stable, and without infection. The wound was closed and the patient was discharged and did well at her postoperative appointment. Discussion: Solid silicone facial implants have been used with great success for a few decades by different specialties. A variety of complications have been reported, such as displacement, early and late infections, patient dissatisfaction with the result, bony resorption, and prolonged edema. This is the first reported case of heterotopic bone formation around a solid silicone implant to this author's knowledge. Conclusion: Heterotopic bone formations around a solid silicone implant likely result from an intact periosteum in conjunction with the nature of the silicone capsules.

Heterotopic Ossification After Minimally Invasive Rotator Cuff Repair

Heterotopic ossification is a common phenomenon after spinal cord injury, head injury, neurologic disorders, burns and other trauma, and joint arthroplasty. Periarticular ossifications after shoulder surgery have been known to occur since the 19th century, at an incidence of up to 27%. After arthroscopic and minimally invasive shoulder surgical procedures were introduced and came into broad use, reports about heterotopic ossification became very rare. We describe here a case of heterotopic bone formation in the subdeltoid fascia after arthroscopic subacromial decompression, acromioclavicular joint resection, and mini-open rotator cuff reconstruction were performed with 2 absorbable suture anchors 3 months postoperatively. Computed tomography (CT) confirmed a massive heterotopic ossification of the deltoid muscle. During revision surgery, a 4 × 6.5-cm bone shell that consisted primarily of immature trabecular bone and lamellar bone in smaller proportions was removed. The case presented here is unique in the scientific literature. Although risk factors have been identified, the underlying pathomorphogenetic mechanism of such heterotopic bone formation remains unclear. Prophylactic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or radiation for arthroscopic or minimally invasive shoulder surgery is not justified, given the low incidence of heterotopic ossification and the known adverse effects. Apparently, information on basic science and on evidence-based therapy is lacking.

Mesenteritis osificante

We report a case of heterotopic bone formation in the mesentery. A 64-year-old man presented with abdominal pain and stiffness two months after undergoing several surgical interventions for hemorrhagic colitis. The diagnosis was heterotopic mesenteric ossification. We describe the imaging findings and review the literature.

Acute total hip arthroplasty for selected displaced acetabular fractures: two to twelve-year results.

We assessed the role of acute total hip arthroplasty in a selected group of patients with a displaced acetabular fracture and complicating features that greatly diminished the likelihood of a favorable outcome after open reduction and internal fixation. Between 1985 and 1997, fifty-seven patients underwent an acute total hip arthroplasty for a displaced acetabular fracture. Patients were followed for a mean of 8.1 years (range, two to twelve years). The mean time from the injury to the arthroplasty was six days (range, one to twenty days). The mean age of the patients at the time of the arthroplasty was sixty-nine years (range, twenty-six to eighty-nine years). Indications for the acute arthroplasty included intra-articular comminution as well as full-thickness abrasive loss of the articular cartilage, impaction of the femoral head, and impaction of the acetabulum that involved >40% of the joint surface and included the weight-bearing region. At the time of the latest follow-up, the mean Harris hip score was 89 points (range, 69 to 100 points); forty-five patients (79%) had an excellent or good outcome. There were six cases of heterotopic bone formation, including one of symptomatic grade-IV ossification. During the initial six postoperative weeks, the acetabular cups subsided an average of 3 mm medially and 2 mm vertically. All of the cups then stabilized, and none were loose at the latest follow-up evaluation. Six patients had excessive medialization of the cup, but none had late loosening or osteolysis. Nine cups (16%) had notable polyethylene wear, but none were revised. No cup or stem had late clinical or radiographic evidence of loosening. There were three late procedures: one for revision of a malaligned cup because of recurrent dislocations, one for removal of hardware from the greater trochanter, and one for excision of heterotopic bone. In selected patients with a displaced acetabular fracture that has a low likelihood of a favorable outcome after fracture treatment, an acute total hip arthroplasty may provide an alternative means with which to achieve a painless, mobile hip. These complex procedures are best undertaken by a surgical team with substantial experience with both acetabular trauma and hip arthroplasty.

Heterotopic calcification in abdominal wounds

Background Heterotopic bone formation in abdominal incisions is a recognized but uncommon sequela of abdominal surgery. The condition of heterotopic bone formation in the abdominal scar may not only cause physical and/or emotional discomfort for the patient but also mimic a retained foreign body or recurrence of a malignant condition. All cases of two surgeons representing a wide variety of general and thoracic surgery were reviewed, and three primary cases and one recurrent case of heterotopic bone formation in an abdominal wound were identified. These cases are compared with the cases available in the English literature to enhance the recognition, appropriate diagnosis, and treatment options available for the patient with this unusual condition. Methods All cases for two surgeons representing a variety of general and thoracic surgery were reviewed. Three patients with painful heterotopic calcification of an abdominal incision requiring excision were identified. One patient had undergone an upper midline laparotomy for pancreatitis and the other two had undergone median sternotomy for cardiac surgery. One of these patients developed a painful recurrence of upper linea alba calcification. All patients were male and ranged in age from 51 to 74 years. Primary heterotopic calcification of the upper linea alba occurred between 2 and 4 months for all patients. All cases were treated with excision and primary tissue closure. The case of recurrent calcification occurred 11/2 months after primary closure, and was treated with re-excision and 1,200 centirads of postoperative radiotherapy to the incision area over 3 days, starting on postoperative day 1. The 2 cases of primary heterotopic calcification successfully treated with the initial excision have been followed for 2 and 6 years respectively without recurrence. The case of recurrent heterotopic calcification treated with re-excision and postoperative radiotherapy has been followed for 10 months without recurrence.

Posttraumatic heterotopic bone formation and peptic ulcer in abdominal scars

A case of heterotopic bone formation in the abdominal wall in combination with a gastrojejunal ulcer in the bony mass is presented. The pathogenesis of the condition is discussed. A literature search failed to reveal information of how to prevent this situation.

경부에 발생한 거대한 이소성 골형성증 치험 1례

경부에 발생한 거대한 이소성 골형성증 치험 1례

A Case of Heterotopic Bone Formation in Laparotomy Scar

A Case of Heterotopic Bone Formation in Laparotomy Scar

Heterotopic bone formation in abdominal operation scars: Report of six cases with review of the literature

Six cases of heterotopic bone formation in abdominal operation scars are presented, and the literature on the subject is reviewed.

A Case of Heterotopic Bone Formation in Abdominal Operation Scar

A Case of Heterotopic Bone Formation in Abdominal Operation Scar

OSTEOSIS CUTIS

SummaryA case of heterotopic bone formation in the scalp of a 39 year old woman is presented, with the relevant radiological and pathological findings.A review of the previous literature is given and the lesion is discussed with reference to other examples of heterotopic ossification.Factors such as trauma, ischaemia and inflammation are seen to be important predisposing factors in the formation of bone at abnormal sites.A group of cases exists in which bone formation in the skin occurs without apparent cause. These can be grouped together under the descriptive term of osteosis cutis. They do not act as true neoplasms, some are hamartomas, the remainder are due to localized or diffuse metaplasia of connective tissue due to unknown stimuli.

Heterotopic bone formation associated with hernia following gastrectomy

An unusual case of heterotopic bone formation associated with a hernia thirteen months following gastrectomy is presented. Although the wound separation was considered superficial at the time of occurrence, it may well have been a factor in the bone and hernia formation. The persistently positive serology in spite of large amounts of antibiotics should also be considered in the etiology of this case.