Healing an ischial tuberosity pressure ulcer in a patient with neurogenic heterotopic ossification: a case report

Neurogenic heterotopic ossification (NHO) is widely recognised as an aberrant bone formation in soft tissue following central nervous system injury. It is most frequently associated with pain and limited movement, especially in the hip. However, it may be neglected in patients with paraplegia with a pressure ulcer (PU). We report the case of an 18-year-old male patient who presented with a hard-to-heal ischial tuberosity PU and who had undergone three operations at other hospitals during the previous six months, which had failed to repair the PU. There was a history of paraplegia as a consequence of spinal cord injury two years previously. Computed tomography and three-dimensional reconstruction showed massive heterotopic ossification (HO) in the wound bed and around the right hip. Histological findings were consistent with a diagnosis of HO. The HO around the wound was completely excised, negative pressure wound therapy was used to promote granulation, and a gluteus maximus musculocutaneous flap was used to cover the wound. We conclude that for patients with paraplegia, with a hard-to-heal PU, it should be determined whether it is associated with NHO. Surgical resection of HO surrounding the wound and improving the microcirculation are critical for repair and reconstruction of these PUs.

A Traumatic Partial Through-the-Elbow Amputation with Disarticulation of the Humerus: A Case Report and Review of the Literature

CASE

A fifty-two-year-old fisherman sustained a severely mangled open elbow dislocation; the distal part of the humerus was protruding from the wound. Although all of the soft tissue attached to the distal part of the humerus was stripped off the bone, no neurovascular structures were damaged. A hinged external fixator was applied and a lateral collateral ligament repair was performed. At the final follow-up, the range of elbow motion was -10° in extension and 125° in flexion, with no instability.

CONCLUSION

Despite the near amputation of the limb, a good functional outcome was achieved because the neurovascular structures remained intact.