Post-traumatic Myositis Ossificans Research Articles

Primary Extrathoracic Extraskeletal Osteosarcoma of the Chest Wall: A Rare Entity

Extraskeletal osteosarcoma (ESOS) is a rapidly growing malignant neoplasm-producing osteoid, located in the soft tissues other than bones or periosteum. Primary ESOS presenting in extrathoracic locations is very rare. The optimal treatment of ESOS is largely unknown. The most common location is the soft tissues of the thigh (46%), upper extremity (20%), intrathoracic (rare), and retroperitoneum (17%). These tumors are usually large while diagnosis, typically measures 10 cm in diameter. The diagnosis is by core biopsy and microscopy sections reveal spindle cells with high NC ratio, myxoid stroma, osteoid matrix, and necrosis. Immunohistochemistry reveals that the tumor cells are positive for Desmin (40%), CD99 (25%), NKX2.2 (30%), and myogenin (15%). The radiological differentials include posttraumatic myositis ossificans. The treatment consists of wide surgical resection and reconstruction depends on the defect. Patients with localized disease were treated with an osteosarcoma-type adjuvant chemotherapy regimen consisting of doxorubicin, and cisplatin. The prognosis is poor when compared with intra-osseous osteosarcoma. More than 90% of patients develop local and distant metastasis and recurrence is between 2 months and 10 years. We hereby describe the case of giant ESOS of the chest wall, which was managed successfully at our center. A 58-year-old male presented with rapid progressive malignant ESOS in the right side chest 20 cm × 20 cm. He was managed by a multidisciplinary team of oncosurgery, plastic surgeon, and onco medicine by neoadjuvant chemotherapy and wide local excision with latissimus dorsi pedicle reconstruction. On a 3-year follow-up, he had no recurrence and doing well.

Case report of post traumatic myositis ossificans in lateral head of gastrocnemius

Myositis Ossificans [MO], a florid ossification, may occur in muscles and soft tissue. It is also called by many different names. The lesion contains actively proliferating fibroblasts and osteoblasts and early in its development may be confused with a malignant tumor. It commonly affects vigorous young men and more so among athletes. Most often involved are the flexor muscles of the arm and the quadriceps femoris. By time of presentation, ossification is extensive and the benign nature of the lesion is usually evident on radiological studies. While literature shows that MO Is common in the flexor muscles of the arm, the hamstrings and quadriceps femoris, it is noted that other muscles of the around the knee joint can also be affected as demonstrated in the case presented here.

Post-traumatic myositis ossificans: a benign lesion that simulates malignant bone and soft tissue tumours.

Myositis ossificans (MO) is a benign bone formation in an extra-skeletal location. The most common subtype of MO, the post-traumatic, usually develops in young males after a traumatic event or sports injury.MO may simulate malignant bone lesions such as extra-skeletal or surface osteosarcomas, or soft tissue sarcomas such as synovial sarcoma or undifferentiated pleomorphic sarcoma. In the early phase the diagnosis of MO is challenging because imaging and histopathological findings may be non-characteristic.Detailed medical history as well as clinical examination, follow-up imaging studies and histological assessment are crucial for a proper diagnosis. Early and accurate differential diagnosis between MO and malignant soft tissue and bone tumours is important to maximize.Cite this article: EFORT Open Rev 2021;6:572-583. DOI: 10.1302/2058-5241.6.210002

Myositis ossificans-a rare tumor of the chest wall.

Myositis ossificans (MO) is the abnormal formation of benign heterotopic bone tissue in soft tissues or muscles, mostly in sites of trauma. Though it has been described in most parts of the body, less than a dozen cases involving the chest wall have been reported. It is known to resolve spontaneously and various medical treatments have been suggested to hasten its resolution. Large tumors, suspicion of malignancy, and presence of symptoms are indications for surgical intervention. The differential diagnoses include sarcomas, infections, callous, calcified hematomas, and cysts. We present the clinical, radiological, and pathological images of a posttraumatic MO of the chest wall, arising from under the medial third of the clavicle and growing into the deeper surface of the pectoralis major muscle. The patient is doing well eightmonths after the excision of the same.

A case of myositis ossificans traumatica on one skeleton from Viminacium

The Roman city and military camp of Viminacium is situated between the villages of Stari Kostolac and Drmno, 12 kilometres north-east of Pozarevac, close to the confluence of the Mlava and the Danube. During its history, it became the biggest urban settlement and the capital of the province of Upper Moesia (Moesia Superior), later First Moesia (Moesia Prima). In one of the necropoles of Viminacium, Pecine, in grave No. 5785, skeletal remains of a juvenile male individual were discovered. The burial took place in Late Antiquity. Anthropological analyses revealed a fracture of the right femur followed by myositis ossificans traumatica. The trauma to the bone can damage the overlying muscle and, occasionally, the muscle tissue will respond to the trauma by producing bone directly in the muscle tissue itself. This condition is known as myositis ossificans traumafica (post-traumatic myositis ossificans or myositis ossificans circumscripta) and is most likely to occur in response to trauma in young male individuals, and in the femoral (the quadriceps muscles) or humeral region (brachium muscles).

Surgical excision of symptomatic mature posttraumatic myositis ossificans: characteristics and outcomes in 32 athletes.

The purpose of this study was to report characteristics and outcomes of surgical excision of symptomatic mature posttraumatic myositis ossificans in adult athletes. The hypothesis was that surgical excision of the ossified mass in these circumstances can effectively relief symptoms and result in return to high-level sports with minimal postoperative complications. All operations involving excision of posttraumatic heterotopic ossifications performed between 1987 and 2015 were reviewed. Included cases had isolated excision of posttraumatic myositis ossificans, whereas excluded cases had: (1) concomitant reattachment of tendon to bone; (2) chronic overuse injuries which preceded the development of the heterotopic mass or large calcifications which were excised from tendon-to-bone insertions; and (3) excision of heterotopic ossification from a ligament, capsule, or tendon insertion following avulsion injury without tendon-to-bone repair. After surgery, return to sports was allowed at 4-6weeks. Of 57 athletes undergoing excision of heterotopic ossifications, 32 were eligible as isolated excision of posttraumatic myositis ossificans. Twenty-four (75%) were ice hockey or soccer players. Median age was 23years. Prior to surgery, patients were unable to continue their sports. At surgery, the ossification was excised from a thigh muscle in 27 (84%) cases. Median follow-up was 2years (range 1-20years). Outcome was Good/Excellent in 26 (81%) patients, corresponding to return to preinjury sports with minimal symptoms at sports activities. Preinjury Tegner activity level was resumed after surgery in 30 of 32 (94%) athletes, of whom 28 (94%) were involved in high-level sports corresponding to Tegner levels 8-10. No postoperative complications were recorded other than minimal insensitive areas at the periphery of skin incisions. In high-level athletes who present chronic disabling mature posttraumatic myositis ossificans that interferes with their sports career, surgical excision of the heterotopic mass results in effective clinical improvement with return to sports and minimal postoperative risks. Case series, Level IV.

Post-traumatic myositis ossificans

Post-traumatic myositis ossificans (PTMO) is characterised by abnormal heterotopic boneformation involving striated muscle. PTMO is usually associated with trauma and is most common in the second and third decades. An important teaching point is that in the early or subacute phase, clinical and imaging features can mimic a soft-tissue sarcoma. A combination of imaging modalities is required to evaluate the muscle lesion.

Post-infectious myositis ossificans in medial, lateral pterygoid muscles: A case report and review of the literature.

Myositis ossificans (MO) is a disease where heterotropic bone forms within a muscle or other type of soft tissue. MO is classified into two groups, MO progressiva and post-traumatic MO. It rarely occurs in the masticatory muscles and thus, only 20 cases involving the masticatory muscles have been reported since 2001. The majority of the reported cases occurred due to trauma, repeated injury or surgical manipulation. However, in a small number of cases, no specific traumatic event was identified as the cause of MO. To the best of our knowledge, this is the first case of post-infectious MO to be reported in the medial and lateral pterygoid muscles.

Ultrasonography and Radiography to Identify Early Post Traumatic Myosistis Ossificans in an 18-Year-Old Male: A Case Report

ObjectiveThe purpose of this case report is to describe a patient with post traumatic myositis ossificans (PTMO) of the anterior thigh following blunt trauma and discuss the incidence, clinical presentation, management, and imaging findings. Clinical featuresAn 18-year-old male presented to a chiropractic clinic with a chief complaint of left knee pain and reduced range of motion after an impact injury to his left anterior thigh during hurdling 6 weeks earlier. Immediately after the injury, he presented to the emergency department where radiography of the left knee was negative and he was diagnosed with a muscle sprain. Follow-up radiography and ultrasonography of the left knee in a chiropractic radiology department revealed ossification consistent with PTMO within his vastus intermedius. Intervention and outcomeThe patient underwent a course of rehabilitation for 2 months including ice, class IV cold laser and vibration applied to his anterior thigh, and myofascial release of his quadriceps musculature with targeted and progressive rehabilitative exercises. His left knee pain resolved within 2 weeks of care. He resumed sports participation (American football) pain-free, while wearing protective padding over the affected thigh, 1 month after presentation, which was approximately 2 1/2 months following his injury. ConclusionThis case demonstrates that ultrasonography may have the capability to detect early phases of PTMO approximately 2 weeks prior to radiographic evidence and to monitor progression throughout its course.

PARAVERTEBRAL MASSES IN BLUE-TAILED MONITOR,VARANUS DORIANUS,INDICATIVE OF SOFT-TISSUE INFECTION WITH ASSOCIATED OSTEOMYELITIS

Paravertebral osseous masses in reptiles have been attributed to Paget's disease on the basis of histology. Histologically recognized mosaic architecture and cement lines, however, lack specificity. A Varanus dorianus with this condition was subjected to standard and computerized tomography. Because the masses were extraskeletal in nature, Paget's disease could be excluded. Although interpretation of the computed tomography suggested the process to be entirely extraskeletal, standard radiographs revealed disorganized vertebral architecture characteristic of osteomyelitis, crossing intervertebral spaces. Posttraumatic myositis ossificans and calcified hematoma were confidently excluded as diagnoses. The etiology of paraspinal masses in this V. dorianus appears attributable to infection, with infection of a puncture wound hypothesized as the underlying process. If one extrapolates the findings in this one animal, it seems reasonable to suggest that consideration be given to investigating the possibility of an infectious origin when similar masses are recognized in other reptiles.

Post traumatic myositis ossificans: Sonographic findings

The aim of this paper is to describe the sonographic (US) features of post traumatic myositis ossificans (PTMO). Fifteen patients with histopathological diagnosis of PTMO were included. The following US parameters were evaluated: presence of a mass, calcifications, power Doppler signals, and relationship with adjacent structures. Five patients (33.3%) were diagnosed as early PTMO and 10 (66.6%) as mature PTMO. In both early and mature PTMO, US showed an oval hypoechoic mass, without infiltrative borders, located in a muscular belly. In the early phase, a center of less echogenicity was observed, associated with an outer sheet-like hyperechoic peripheral rim, while, in the mature phase, peripheral calcification created more reflections and distal acoustic shadowing was observed. US is highly sensitive in the detection of PTMO, helps differentiate between PTMO and malignant soft tissue tumors, and can be used for follow-up of the lesions.

Myositis ossificans as a complication of hamstring autograft harvest for open primary anterior and posterior cruciate ligament and posterolateral corner reconstruction

Post-traumatic myositis ossificans is a benign condition of heterotopic ossification of unknown aetiology which typically is related to trauma from a single blow or repeated episodes of microtrauma. A case of myositis ossificans that developed after hamstring autograft harvest for an open cruciate ligament and posterolateral corner reconstruction is described, a previously unrecognised complication of this procedure.

The Imaging of Myositis Ossificans

Myositis ossificans (MO) is characterized by abnormal heterotopic bone formation involving striated muscle, tendons, ligaments, fasciae, and aponeuroses. Myocardium, the diaphragm, tongue, larynx, smooth muscle, and sphincters are all spared. Several subtypes of myositis ossificans exist: posttraumatic myositis ossificans (PTMO), nontraumatic/pseudomalignant myositis ossificans, and myositis ossificans progressiva (MOP). This article reviews the clinical features and differential diagnoses of each subtype of MO and illustrates the typical imaging features demonstrated by plain radiography, ultrasound, radionuclide bone scans, computed tomography, and magnetic resonance imaging.

Myositis ossificans traumatica der Hohlhand

We present a 27-year-old female patient who developed a post-traumatic myositis ossificans with pain and restricted function after trigger finger release of the middle finger. After tumour resection an early recurrence made a re-resection necessary, followed by radiotherapy. Three years postoperatively the patient is free of complaints.

Shock Waves in the Treatment of Post-Traumatic Myositis Ossificans

Myositis ossificans (MO) is a fairly common evolution in sports activity and can be due to direct trauma or to repeated micro-injuries. The traditional therapeutic approach relies on a variety of treatments, such as physical therapy but evidence of their proven clinical efficacy is lacking. The latest therapeutic option is surgical removal but this is a demolitive procedure and is frequently associated with a significant loss of functional integrity. There are few articles in literature about the treatment of post-traumatic MO, and none on extracorporeal shock wave therapy (ESWT). We illustrate a case series of 24 sportsmen treated with three sessions of electro-hydraulic shockwave therapy and an associated rehabilitation program. Only a partial reduction of the ossification was observed in the X-ray images but all the patients showed signs of functional improvement immediately after therapy. Two months after the therapy, a normal range of motion and no signs of weakness were observed. Three months after treatment, 87.5% of patients resumed regular sports activities. (E-mail: angelanotarnicola@yahoo.it)

Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report.

BackgroundFractures of the clavicle are common injuries. The complications have been well documented in the literature.Case presentationDespite it close proximity to the sternocleidomastoid muscle and myositis ossificans recognised as a known complication of any fracture, the two have never previously been described in association secondary to a fracture of the clavicle. We present a case where myositis ossificans affecting the sternocleiodomastoid was detected in the post-injury phase of a clavicle fracture.ConclusionThis case highlights that traumatic myositis ossificans circumscipta can arise in the sternocleidomastoid muscle following a fracture of the medial third of the clavicle.

Post-traumatic Myositis Ossificans Circumscripta

A 66-year-old woman presented with painful gait and a large, firm, nonmobile mass in her right foot. She had undergone four previous surgeries to remove a recurring "calcified hematoma" that resulted from an injury sustained 3 decades previously. An unusually large ossific mass (7.0 x 7.0 x 2.0 cm) consistent with post-traumatic myositis ossificans circumscripta was excised. After 3 years of follow-up, there was no return of the symptoms or the mass.

Characterization of bone forming cells in posttraumatic myositis ossificans by lectins

Lectins were used to characterize bone forming cells in posttraumatic myositis ossificans. The lectins applied were as follows: Arachis hypogaea (PNA): specific for beta-D-galactose (1,3)N-acetyl-D-galactosamine (Gal-1,3 GalNac), Canavalia ensiformis (Con A): specific for alpha-D-glucose (D-Glc) and alpha-D-mannose (D-Man) and Wheat germ (WGA): specific for N-acetyl(1,4)D-glucosamine (Glc-NaC) and neuraminic acid. The development of myositis ossificans was characterized by the appearance of a WGA binding cell population. The lectin-binding sites appeared as a cluster in the supranuclear cytoplasm, corresponding to the Golgi-complex. However, the WGA lectin-binding sites disappeared in the mature form of myositis ossificans. We assume that these lectin binding cells may be the bone marrow derived precursors of myofibroblast-like cells which are responsible for bone formation within the damaged muscle.

Heterotopic Bone Formation After Noncemented Total Hip Arthroplasty

The regional-development of heterotopic bone around the hip and the influence of postoperative prophylaxis with antiinflammatory drugs were studied in 66 patients treated with 74 noncemented, porous-coated total hip arthroplasties (THA) using the McFarland approach. Thirty patients (34 hips) were treated with antiinflammatory drugs during the early postoperative period. Heterotopic bone developed in two different regions: central, around the neck of the femoral component, and lateral to the greater trochanter of the femur. Central ossifications were recorded in 53% of the hips and appeared significantly less frequently in patients postoperatively treated with antiinflammatory drugs. Lateral ossifications were recorded in 71% of the hips, and no significant prophylactic effect was found for postoperative antiinflammatory treatment. In response to the McFarland approach in THA, heterotopic ossifications may appear both centrally around the neck of the femoral component and lateral to the trochanter in the substance of the medial gluteal muscle. The latter may be comparable to post-traumatic myositis ossificans.

The ?Pelvic digit? ? An unusual developmental anomaly

Five cases of a rare developmental anomaly involving extraskeletal bone formation are described--four in the pelvis and one arising from the 12th rib. Three of these bony growths, called "Pelvic digits" had well developed "joints" or pseudoarticulations. The similarity of this anomaly to posttraumatic myositis ossificans and avulsion injuries of the pelvis (rectus femoris) is pointed out and a differential diagnosis offered.