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Won P, Pickering TA, Schneider JC, Kowalske K, Ryan CM, Carrougher GJ, Stewart BT, Yenikomshian HA. Physical and psychosocial outcomes among burn-injured people with heterotopic ossification: A burn model system study. Burns 2024; 50:957-965. [PMID: 38267289 PMCID: PMC11055684 DOI: 10.1016/j.burns.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Heterotopic ossification (HO), or ectopic bone formation in soft tissue, is a not so rare and poorly understood debilitating sequela of burn injury. Individuals developing HO following burn injuries to their hands often experience reductions in mobility, significant contractures, and joint pain. This study identifies demographic characteristics of individuals who develop HO and compares their physical and psychosocial outcomes to the general burn population. METHODS Participant demographics, injury characteristics, and PROMIS-29 scores across three time points (discharge, six- and 12- months after injury) were extracted from the Burn Model System National Longitudinal Database representing participants from 2015-2022. Mixed-effects linear regression models were used to compare PROMIS scores across all three longitudinal measurements. Models were adjusted for age, sex, race/ethnicity, HO status, and burn size. RESULTS Of the 861 participants with data concerning HO, 33 were diagnosed with HO (3.8% of participants). Most participants with HO were male (n = 24, 73%) and had an average age of 40 + /- 13 years. Participants with HO had significantly larger burn size (49 +/-23% Total Body Surface Area (TBSA)) than those without HO (16 +/-17%). Participants with HO reported significantly worse physical function, depression, pain interference and social integration scores than those without HO. After adjusting for covariables, participants with HO continued to report statistically significantly worse physical function than those without HO. Although physical functioning was consistently lower, the two populations did not differ significantly among psychosocial outcome measures. CONCLUSIONS While HO can result in physical limitations, the translation to psychosocial impairments was not evident. Targeted treatment of HO with the goal of maximizing physical function should be a focus of their rehabilitation. LEVEL OF EVIDENCE 2b TYPE OF STUDY: Symptom Prevalence Study.
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Affiliation(s)
- Paul Won
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
| | - Colleen M Ryan
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Gretchen J Carrougher
- Department of Surgery, University of Washington, UW Medicine Regional Burn Center at Harborview Medical Center, Seattle, WA, USA
| | - Barclay T Stewart
- Department of Surgery, University of Washington, UW Medicine Regional Burn Center at Harborview Medical Center, Seattle, WA, USA
| | - Haig A Yenikomshian
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Oropallo A, Beneat A, Rao A, Goodman E. Revisiting Heinz-Lippman disease as a complication of chronic venous insufficiency. J Vasc Surg Cases Innov Tech 2024; 10:101408. [PMID: 38389931 PMCID: PMC10882172 DOI: 10.1016/j.jvscit.2023.101408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/14/2023] [Indexed: 02/24/2024] Open
Abstract
Chronic venous insufficiency with and without ulceration is a common complication of varicose veins. Heinz-Lippmann disease is a potentially underreported complication of chronic venous insufficiency that involves heterotopic ossification of the peri-wound that might contribute to the chronicity of venous leg ulcers. Most commonly, heterotopic ossification is associated with traumatic injury. We report the cases of three patients with chronic venous insufficiency and no history of trauma who were found to have subcutaneous calcifications consistent with Heinz-Lippmann disease. Osteomyelitis was confirmed in two patients. Physical examination and diagnostic imaging can be helpful in determining the diagnosis. Interventions can include biopsy to rule out osteomyelitis, with subsequent treatment, if needed.
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Affiliation(s)
- Alisha Oropallo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Department of Vascular Surgery, Northwell Health, Manhasset, NY
- Northwell Health Comprehensive Wound Care Center, North Shore University Hospital, Lake Success, NY
| | - Amanda Beneat
- Northwell Health Comprehensive Wound Care Center, North Shore University Hospital, Lake Success, NY
| | - Amit Rao
- Northwell Health Comprehensive Wound Care Center, North Shore University Hospital, Lake Success, NY
| | - Eric Goodman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Department of Radiology, Northwell Health, Manhasset, NY
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Kontokostopoulos AP, Gkiatas I, Vasileiadis GI, Flevas D, Tsirigkakis SE, Kosmas D, Kostas-Agnantis I, Pakos E, Gelalis I, Korompilias A. Heterotopic Ossification around the Elbow Revisited. Life (Basel) 2023; 13:2358. [PMID: 38137958 PMCID: PMC10744911 DOI: 10.3390/life13122358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 10/31/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Heterotopic ossification (HO) is the process of ectopic bone formation in the periarticular soft tissues and is usually formed in the elbow, hip and knee joint as a complication of trauma, burns, brain injury or surgical procedures. The development of HO around the elbow joint can cause a severe limitation of range of motion (ROM) and may affect daily activities of the patient. Treatment of ectopic bone formation around the elbow is a challenge for many surgeons. Non-operative treatment usually fails to restore the ROM of the elbow joint; thus, surgery is necessary to restore the function of the joint. In the past, many surgeons suggested that a delayed excision of HO, until maturation of the ectopic bone, is the best option in order to avoid any possible recurrence. However, many authors now suggest that this delay may lead to complications such as muscular atrophy and formation of soft tissue contractures that can cause a greater impairment of elbow function; thus, early excision is a better option and can better restore the elbow ROM. We performed a literature research of articles that investigated which is the best time of HO excision and we also evaluated if the tethering effect of HO can lead to a greater impairment of the elbow function. We found numerous studies suggesting that a limitation in ROM of the elbow can appear from the tethering of the ectopic bone formation and not only from primary HO. Concerning the HO excision, there were no significant differences between patients who underwent delayed and early excision, concerning the recurrence rate of HO around the elbow. Patients who underwent early excision had better restoration of elbow ROM; thus, early excision, combined with a rehabilitation program, is reported to be the best option for these patients.
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Affiliation(s)
- Aristeidis-Panagiotis Kontokostopoulos
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Ioannis Gkiatas
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - George I. Vasileiadis
- Department of Physical Medicine and Rehabilitation, School of Medicine, University Hospital of Ioannina, 451 10 Ioannina, Greece;
| | - Dimitrios Flevas
- Arthroscopy & Orthopaedic Surgery Department, Metropolitan Hospital, Neo Faliro, 185 47 Pireas, Greece;
| | - Spyridon E. Tsirigkakis
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Dimitrios Kosmas
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Ioannis Kostas-Agnantis
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Emilios Pakos
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Ioannis Gelalis
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
| | - Anastasios Korompilias
- Department of Orthopaedic Surgery, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece; (I.G.); (S.E.T.); (D.K.); (I.K.-A.); (E.P.); (I.G.); (A.K.)
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Cherry I, Mutschler M, Samara E, Merckaert S, Zambelli PY, Tschopp B. Myositis ossificans in the pediatric population: a systematic scoping review. Front Pediatr 2023; 11:1295212. [PMID: 38161430 PMCID: PMC10757320 DOI: 10.3389/fped.2023.1295212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Circumscribed or pseudomalignant myositis ossificans (MO) is a rare and benign condition characterized by heterotopic bone formation in soft tissues. The clinical presentation of MO, imaging investigations, histological findings, and treatment strategies are unclear, especially in the pediatric population. Materials and methods A literature search was conducted in PubMed, Scopus, and Google Scholar electronic databases to identify original articles and reviews in English or French of traumatic and non-traumatic MO. Studies were selected by 2 independent reviewers following the PRISMA recommendation and descriptive data were extracted. We harvest in each case the sex, age at diagnosis, location, presence of initial trauma, pre-emptive diagnosis, modalities of imagery used, realized biopsy, treatment performed, and type of follow-up. Results Sixty pediatric cases of MO were identified between 2002 and 2023. Twenty-three patients (38.3%) were diagnosed with idiopathic/pseudomalignant and 37 patients (61.7%) with circumscribed. The mean age at diagnosis was 9.5 years (range 0.2-17 years), with a male-to-female ratio of 1:1. The initial pre-emptive diagnosis was neoplasia in 13 patients (21.7%). The biopsy was percutaneous in 9 patients (15%) and incisional in 7 patients (11.7%). Histological analysis was achieved in 35 cases (57%). Surgical excision was the first line treatment in 46.7% of patients, and non-surgical in the remaining patients. The follow-up strategy was clinical in 16 patients (26.7%) or based on imaging investigation in 23 patients (38.3%). Discussion Although MO in children is described as a rare pathology, identifying the benignity of the condition is essential to avoid unnecessary invasive treatment and to avoid delaying the treatment of a potentially life-threatening entity. It seems that there is no consensus established concerning the proper imaging for diagnosis. Clinicians should acknowledge that the absence of a triggering trauma tends to direct the investigation and the management toward a surgical attitude. Conservative management is key, however, surgical excision can be proposed on matured lesions on a case-by-case basis. The absence of recurrence is not excluded. Therefore, a close clinical follow-up is suggested for all cases. The true benefit of a radiological is questioned in a question known to be self-resolving.
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Liang K, Gani MH, Griffin X, Culpan P, Mukabeta T, Bates P. Acute versus delayed total hip arthroplasty after acetabular fracture fixation: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2683-2693. [PMID: 36810707 PMCID: PMC10504200 DOI: 10.1007/s00590-023-03489-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Post-traumatic osteoarthritis (PTOA) is a disabling complication of open reduction and internal fixation (ORIF) for acetabular fractures. There is a trend towards acute total hip arthroplasty (THA), 'fix-and-replace', in patients considered to have a poor prognosis and likelihood of PTOA. Controversy remains between early fix-and-replace, versus delayed THA as required after initial ORIF. This systematic review included studies comparing functional and clinical outcomes between acute versus delayed THA after displaced acetabular fractures. METHODS Comprehensive searches following the PRISMA guideline were performed on six databases for articles in English published anytime up to 29 March 2021. Two authors screened articles and discrepancies were resolved by consensus. Patient demographics, fracture classification, functional and clinical outcomes were compiled and analysed. RESULTS The search yielded 2770 unique studies, of which five retrospective studies were identified with a total of 255 patients. Of them, 138 (54.1%) were treated with acute and 117 (45.9%) treated with delayed THA. Delayed THA group represented a younger cohort compared to the acute group (mean age, 64.3 vs 73.3). The mean follow-up time for the acute and delayed group was 23 and 50 months, respectively. There was no difference in functional outcomes between the two study groups. Complication and mortality rates were comparable. Delayed THA had a higher revision rate compared to the acute group (17.1 vs 4.3%; p = 0.002). CONCLUSION Fix-and-replace had functional outcomes and complication rates similar to ORIF and delayed THA, but lower revision rates. Although the quality of studies was mixed, sufficient equipoise now exists to justify randomised studies in this area. PROSPERO registration: CRD42021235730.
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Affiliation(s)
- Kaifeng Liang
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.
| | | | - Xavier Griffin
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
- Bone & Joint Health, Barts Health NHS Trust, London, UK
| | - Paul Culpan
- Bone & Joint Health, Barts Health NHS Trust, London, UK
| | | | - Peter Bates
- Bone & Joint Health, Barts Health NHS Trust, London, UK
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Al Khader A, Habaibeh E, Tawalbeh HY, Mansour BM, Mansour SM, Haj Ahmad AN, Owais TT, Odeh H. Myositis ossificans of the chest wall in an 8-year-old boy: a case report of a diagnostic pitfall. Indian J Thorac Cardiovasc Surg 2023; 39:186-189. [PMID: 36785605 PMCID: PMC9918642 DOI: 10.1007/s12055-022-01463-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/01/2023] Open
Abstract
Myositis ossificans of the chest wall is extremely unusual with fewer than a dozen reported cases. In addition, the occurrence in children younger than 10 years is extremely rare. We report a case of an 8-year-old male who presented with painful and progressively enlarging left-sided chest wall mass. The tumor showed close histo-morphological mimicry with osteosarcoma. Moreover, the characteristic radiographic findings of myositis ossificans were absent. The age of the patient and the absence of attachment to the rib helped exclude extra-skeletal and parosteal osteosarcomas, respectively. The patient was doing well 4 months after surgery.
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Affiliation(s)
- Ali Al Khader
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
- Al-Hussein Salt Hospital, Al-Salt, Jordan
| | | | | | | | | | | | - Tala Tariq Owais
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Hadeel Odeh
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
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Abstract
Heterotopic ossification (HO) refers to benign ectopic bone formation in soft tissue and is common following trauma surgery. HO bone can restrict movement and progress into ankylosis that may necessitate surgical intervention. This article discusses the current literature on the pathophysiology, prophylaxis, treatment, and epidemiology of postoperative HO following orthopedic trauma.
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Affiliation(s)
- Jad Lawand
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA.
| | - Zachary Loeffelholz
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
| | - Bilal Khurshid
- Texas College of Osteopathic Medicine, Fort Worth, Texas, USA
| | - Eric Barcak
- Department of Orthopaedic Surgery, John Peter Smith Health Network, Fort Worth, Texas, USA
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Cren PY, Penel N, Cordoba A, Decanter G, Gaboriau L, Ben Haj Amor M. Myositis ossificans circumscripta after surgery and radiotherapy and during sunitinib treatment: a case report. J Med Case Rep 2022; 16:454. [PMID: 36474288 PMCID: PMC9727934 DOI: 10.1186/s13256-022-03664-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/01/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Myositis ossificans circumscripta is a self-limiting, benign, ossifying lesion that can affect any type of soft tissue. It is most commonly found in muscles as a solitary lesion. A history of recent trauma has been reported in approximately 50% of cases. Clinically, MOC presents as a painful swelling, which rapidly increases in size. The pain and inflammatory symptoms spontaneously disappear after approximately 2-6 weeks, and the mass stabilizes or decreases. Radiologically, myositis ossificans circumscripta can be divided into two phases. The first is the acute phase, which is followed by the mature phase 2-6 weeks later. During the acute phase, the radiological aspect does not show any specific abnormality. In the mature phase, plain radiographs and computed tomography show blurred calcifications around a hypodense center. We describe here the first case of myositis ossificans circumscripta, with appropriate follow-up, occurring during sunitinib exposure. CASE PRESENTATION We report a case of myositis ossificans circumscripta in a 34-year-old man (ethnicity unknown) receiving sunitinib for metastatic alveolar soft part sarcoma of the left thigh after surgery and radiotherapy. Four months after the first dose of sunitinib, the patient experienced painful swelling in the surgical scar area. Magnetic resonance imaging showed diffuse and marked edema of the anterior compartment of the thigh, without nodular lesions circumscribing a central core, and without bone signal abnormality. The increased visibility of the intermuscular fascia and convergence of normal muscle fibers (black hole effect), without the displacement seen in tumors, were suggestive of myositis. Therefore, antiangiogenic treatment was discontinued, and the symptoms rapidly resolved within a few days. Three weeks after the discontinuation of sunitinib, the inflammatory findings completely disappeared. Two months after the diagnosis of myositis ossificans circumscripta, plain radiographs and computed tomography showed an extensive calcified mass measuring > 12 cm. The continuation of favorable clinical outcomes was confirmed. CONCLUSIONS To the best of our knowledge, this is the first case of myositis ossificans circumscripta with appropriate follow-up occurring during sunitinib exposure. Owing to multimodal treatment of sarcoma, we cannot rule out the radiotherapy and surgery causality.
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Affiliation(s)
- Pierre-Yves Cren
- grid.452351.40000 0001 0131 6312Département d’oncologie Médicale, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Université de Lille, Lille, France
| | - Nicolas Penel
- grid.452351.40000 0001 0131 6312Département d’oncologie Médicale, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France ,grid.503422.20000 0001 2242 6780Université de Lille, Lille, France
| | - Abel Cordoba
- grid.452351.40000 0001 0131 6312Département de Radiothérapie, Centre Oscar Lambret, Lille, France
| | - Gauthier Decanter
- grid.452351.40000 0001 0131 6312Département de Chirurgie, Centre Oscar Lambret, Lille, France
| | - Louise Gaboriau
- grid.410463.40000 0004 0471 8845Centre Régional de Pharmacovigilance, Service de Pharmacologie Médicale, CHU Lille, Lille, France
| | - Mariem Ben Haj Amor
- grid.452351.40000 0001 0131 6312Département d’imagerie Médicale, Centre Oscar Lambret, Lille, France
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Papalexis N, Peta G, Errani C, Miceli M, Facchini G. Preoperative Arterial Embolization for Heterotopic Ossification of the Hip. J Vasc Interv Radiol 2022; 34:608-612. [PMID: 36481323 DOI: 10.1016/j.jvir.2022.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To investigate the efficacy and safety of preoperative arterial embolization for neurogenic heterotopic ossification (NHO) of the hip. MATERIALS AND METHODS This single-center retrospective study reviewed outcomes in 16 consecutive patients who had surgical resection of NHO of the hip: 8 of whom underwent preoperative arterial embolization and 8 of whom did not. Both patient cohorts had similar baseline characteristics. A mean of 2.62 ± 1.9 arteries per patient, including the gluteal, lateral circumflex femoral, and deep circumflex iliac branches, were embolized using an n-butyl cyanoacrylate (NBCA)-ethiodized oil mixture. Data from both cohorts regarding intraoperative blood loss, volume of blood transfused, complications, and duration of hospitalization were compared. RESULTS A mean of 2.6 ± 1.9 arteries were embolized with NBCA-ethiodized oil, mainly the gluteal arteries, lateral circumflex femoral artery, and deep circumflex iliac artery. In the embolization group, mean intraoperative blood loss was 875 mL ± 320, mean number of units of blood used was 0.5 ± 0.7, and average number of days of hospitalization was 6.4 days ± 1.6. In the control group, mean intraoperative blood loss was 1,350 mL ± 120, mean number of units of blood used was 2 ± 1.1, and average number of days of hospitalization was 11.5 days ± 1.4. The embolization group had an average reduction in blood loss of 40.7% (P = 0.035), reduction in units of blood administered of 75% (P = 0.021), and reduction in days of hospitalization of 44.7% (P = 0.014). No procedural complications were recorded. CONCLUSIONS Preoperative arterial embolization is effective and safe in reducing intraoperative blood loss, number of hospitalization days, and need for blood transfusions in surgical resection of NHO of the hip.
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Affiliation(s)
- Nicolas Papalexis
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Giuliano Peta
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Huenerfauth EI, Molnár V, Rosati M, Ciurkiewicz M, Söbbeler FJ, Harms O, Hildebrandt R, Baumgärtner W, Tipold A, Volk HA, Nessler J. Case Report: Unable to Jump Like a Kangaroo Due to Myositis Ossificans Circumscripta. Front Vet Sci 2022; 9:886495. [PMID: 35865877 PMCID: PMC9295721 DOI: 10.3389/fvets.2022.886495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
A male 10-year-old captive red kangaroo (Macropus rufus) was presented with a chronic progressive pelvic limb lameness and reluctance to jump. The general examination revealed a palpable induration of the lumbar epaxial muscles. Magnetic resonance imaging performed under general anesthesia revealed bilateral almost symmetric, well-circumscribed mass lesions in superficial erector spinae muscles. The lesions had irregular to multilobulated appearance with hyper-, hypo-, and isointense areas in T2- and T1-weighted (w) sequences without contrast enhancement. On computed tomography, a peripheral rim of mineralization was apparent. Histopathological analysis of a muscle biopsy showed osseous trabeculae with rare clusters of chondrocytes indicating metaplasia of muscle tissue to bone. No indications of inflammation or malignancy were visible. The clinical, histopathological, and imaging workup of this case was consistent with myositis ossificans circumscripta. This disorder is particularly well-known among human professional athletes such as basketball players, where excessive, chronic-repetitive force or blunt trauma causes microtrauma to the musculature. Metaplasia of muscle tissue due to abnormal regeneration processes causes heterotopic ossification. The kangaroo's clinical signs improved with cyto-reductive surgery, cage rest, weight reduction, and meloxicam without further relapse.
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Affiliation(s)
- Enrice I. Huenerfauth
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
- *Correspondence: Enrice I. Huenerfauth
| | | | - Marco Rosati
- Section of Clinical and Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Malgorzata Ciurkiewicz
- Department for Pathology, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Franz J. Söbbeler
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Oliver Harms
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Robert Hildebrandt
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department for Pathology, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Andrea Tipold
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Holger A. Volk
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
| | - Jasmin Nessler
- Department of Small Animal Internal Medicine and Surgery, University of Veterinary Medicine Foundation, Hannover, Germany
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Wilke BK, Goulding KA, Sherman CE, Houdek MT. Soft Tissue Tumors. Radiol Clin North Am 2022; 60:253-262. [DOI: 10.1016/j.rcl.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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[Research progress of traumatic heterotopic ossification]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:386-394. [PMID: 35293183 PMCID: PMC8923934 DOI: 10.7507/1002-1892.202110078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review and evaluate the research progress of traumatic heterotopic ossification (HO). METHODS The domestic and foreign related research literature on traumatic HO was widely consulted, and its etiology, pathogenesis, pathological progress, diagnosis, prevention, and treatment were summarized. RESULTS Traumatic HO is often caused by severe trauma such as joint operation, explosion injury, nerve injury, and burn. At present, it is widely believed that the occurrence of traumatic HO is closely related to inflammation and hypoxia. Oral non-steroidal anti-inflammatory drugs and surgery are the main methods to prevent and treat traumatic HO. CONCLUSION Nowadays, the pathogenesis of traumatic HO is still unclear, the efficiency of relevant prevention and treatment measures is low, and there is a lack of specific treatment method. In the future, it is necessary to further study the pathogenesis of traumatic HO and find specific prevention and treatment targets.
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Posttraumatic osseous metaplasia causing reversible palsy of the brachial plexus: case report and review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01815-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Liu D, Qi B, Huang Z, Pan Z. Fibro-Osseous Pseudotumor. Orthopedics 2021; 44:e713-e718. [PMID: 34618638 DOI: 10.3928/01477447-20211001-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Fibro-osseous pseudotumor is an extremely rare subcutaneous benign ossifying lesion associated with bone formation that is most commonly seen in the hands, followed by the toes. Because the tumor has a certain degree of invasiveness, it is often mistaken for malignancy, which leads to radical, excessive treatment. Our case involved a 32-year-old man with lesions on the left index finger. We documented the detailed data of diagnosis, treatment, and follow-up. We also conducted a review and summarized the published cases to advance our understanding of the disease, provide more accurate diagnostic criteria, and avoid inappropriate surgical procedures. [Orthopedics. 2021;44(6):e713-e718.].
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15
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Yang Z, Liu D, Guan R, Li X, Wang Y, Sheng B. Potential genes and pathways associated with heterotopic ossification derived from analyses of gene expression profiles. J Orthop Surg Res 2021; 16:499. [PMID: 34389038 PMCID: PMC8364104 DOI: 10.1186/s13018-021-02658-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Heterotopic ossification (HO) represents pathological lesions that refer to the development of heterotopic bone in extraskeletal tissues around joints. This study investigates the genetic characteristics of bone marrow mesenchymal stem cells (BMSCs) from HO tissues and explores the potential pathways involved in this ailment. Methods Gene expression profiles (GSE94683) were obtained from the Gene Expression Omnibus (GEO), including 9 normal specimens and 7 HO specimens, and differentially expressed genes (DEGs) were identified. Then, protein–protein interaction (PPI) networks and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed for further analysis. Results In total, 275 DEGs were differentially expressed, of which 153 were upregulated and 122 were downregulated. In the biological process (BP) category, the majority of DEGs, including EFNB3, UNC5C, TMEFF2, PTH2, KIT, FGF13, and WISP3, were intensively enriched in aspects of cell signal transmission, including axon guidance, negative regulation of cell migration, peptidyl-tyrosine phosphorylation, and cell-cell signaling. Moreover, KEGG analysis indicated that the majority of DEGs, including EFNB3, UNC5C, FGF13, MAPK10, DDIT3, KIT, COL4A4, and DKK2, were primarily involved in the mitogen-activated protein kinase (MAPK) signaling pathway, Ras signaling pathway, phosphatidylinositol-3-kinase/protein kinase B (PI3K/Akt) signaling pathway, and Wnt signaling pathway. Ten hub genes were identified, including CX3CL1, CXCL1, ADAMTS3, ADAMTS16, ADAMTSL2, ADAMTSL3, ADAMTSL5, PENK, GPR18, and CALB2. Conclusions This study presented novel insight into the pathogenesis of HO. Ten hub genes and most of the DEGs intensively involved in enrichment analyses may be new candidate targets for the prevention and treatment of HO in the future.
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Affiliation(s)
- Zhanyu Yang
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China.,Hunan Emergency Center, No. 90 Pingchuan Road, Changsha, Hunan, 410000, People's Republic of China
| | - Delong Liu
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China.,Hunan Emergency Center, No. 90 Pingchuan Road, Changsha, Hunan, 410000, People's Republic of China
| | - Rui Guan
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China
| | - Xin Li
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China
| | - Yiwei Wang
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China
| | - Bin Sheng
- Department of Orthopaedics and Traumatology, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, No. 61 Jiefang West Road, Changsha, Hunan, 410000, People's Republic of China. .,Hunan Emergency Center, No. 90 Pingchuan Road, Changsha, Hunan, 410000, People's Republic of China.
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16
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Cong Q, Liu Y, Zhou T, Zhou Y, Xu R, Cheng C, Chung HS, Yan M, Zhou H, Liao Z, Gao B, Bocobo GA, Covington TA, Song HJ, Su P, Yu PB, Yang Y. A self-amplifying loop of YAP and SHH drives formation and expansion of heterotopic ossification. Sci Transl Med 2021; 13:13/599/eabb2233. [PMID: 34162750 PMCID: PMC8638088 DOI: 10.1126/scitranslmed.abb2233] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/03/2020] [Accepted: 05/30/2021] [Indexed: 12/15/2022]
Abstract
Heterotopic ossification (HO) occurs as a common complication after injury or in genetic disorders. The mechanisms underlying HO remain incompletely understood, and there are no approved prophylactic or secondary treatments available. Here, we identify a self-amplifying, self-propagating loop of Yes-associated protein (YAP)-Sonic hedgehog (SHH) as a core molecular mechanism underlying diverse forms of HO. In mouse models of progressive osseous heteroplasia (POH), a disease caused by null mutations in GNAS, we found that Gnas-/- mesenchymal cells secreted SHH, which induced osteoblast differentiation of the surrounding wild-type cells. We further showed that loss of Gnas led to activation of YAP transcription activity, which directly drove Shh expression. Secreted SHH further induced YAP activation, Shh expression, and osteoblast differentiation in surrounding wild-type cells. This self-propagating positive feedback loop was both necessary and sufficient for HO expansion and could act independently of Gnas in fibrodysplasia ossificans progressiva (FOP), another genetic HO, and nonhereditary HO mouse models. Genetic or pharmacological inhibition of YAP or SHH abolished HO in POH and FOP and acquired HO mouse models without affecting normal bone homeostasis, providing a previously unrecognized therapeutic rationale to prevent, reduce, and shrink HO.
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Affiliation(s)
- Qian Cong
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Yuchen Liu
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Taifeng Zhou
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Yaxing Zhou
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Ruoshi Xu
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Caiqi Cheng
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Hye Soo Chung
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Meijun Yan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hang Zhou
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Zhiheng Liao
- Department of Orthopaedic Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Bo Gao
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA
| | - Geoffrey A Bocobo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Taylor A Covington
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Hyeon Ju Song
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Peiqiang Su
- Department of Orthopaedic Surgery, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Paul B Yu
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Yingzi Yang
- Department of Developmental Biology, Harvard School of Dental Medicine, Harvard Stem Cell Institute, 188 Longwood Ave., Boston, MA 02115, USA.
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17
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Saad A, Azzopardi C, Patel A, Davies A, Botchu R. Myositis ossificans revisited - The largest reported case series. J Clin Orthop Trauma 2021; 17:123-127. [PMID: 33816108 PMCID: PMC7995649 DOI: 10.1016/j.jcot.2021.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/06/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Myositis ossificans (MO) is a condition characterised by the formation of non-neoplastic heterotropic ossification in extraskeletal soft tissues. MATERIAL AND METHODS We performed a retrospective study of our radiology databases within our tertiary orthopaedic centre to identify all cases of MO, reported on X ray, Magnetic resonance imaging (MRI) and Computed tomography (CT) over the past 13 years (2007-2020). RESULTS We identified 68 cases of MO, which were included into our cohort. The average age of our patients was 36 years (range 4-84 years). 73% of cases (n = 50) were found to affect the lower limb muscles with the majority in the quadriceps. CONCLUSION We report the largest case series of MO and discuss the demographics, diagnoses and management.
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Affiliation(s)
- A. Saad
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C. Azzopardi
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A. Patel
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - A.M. Davies
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
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18
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Wang T, Chen P, Chen L, Zhou Y, Wang A, Zheng Q, Mitchell CA, Leys T, Tuan RS, Zheng MH. Reduction of mechanical loading in tendons induces heterotopic ossification and activation of the β-catenin signaling pathway. J Orthop Translat 2021; 29:42-50. [PMID: 34094857 PMCID: PMC8142054 DOI: 10.1016/j.jot.2021.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/15/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tendons are the force transferring tissue that enable joint movement. Excessive mechanical loading is commonly considered as a primary factor causing tendinopathy, however, an increasing body of evidence supports the hypothesis that overloading creates microdamage of collagen fibers resulting in a localized decreased loading on the cell population within the damaged site. Heterotopic ossification is a complication of late stage tendinopathy, which can significantly affect the mechanical properties and homeostasis of the tendon. Here, we the examine the effect of mechanical underloading on tendon ossification and investigate its underlying molecular mechanism. Method Rabbit Achilles tendons were dissected and cultured in an underloading environment (3% cyclic tensile stain,0.25 Hz, 8 h/day) for either 10, 15 or 20 days. Using isolated tendon-derived stem cells (TDSCs) 3D constructs were generated, cultured and subjected to an underloading environment for 6 days. Histological assessments were performed to evaluate the structure of the 3D constructs; qPCR and immunohistochemistry were employed to study TDSC differentiation and the β-catenin signal pathway was investigated by Western blotting. Mechanical testing was used to determine ability of the tendon to withstand force generation. Result Tendons cultured for extended times in an environment of underloading showed progressive heterotopic ossification and a reduction in biomechanical strength. qPCR revealed that 3D TDSCs constructs cultured in an underloading environment exhibited increased expression of several osteogenic genes: these include RUNX2, ALP and osteocalcin in comparison to tenogenic differentiation markers (scleraxis and tenomodulin). Immunohistochemical analysis further confirmed high osteocalcin production in 3D TDSCs constructs subject to underloading. Western blotting of TDSC constructs revealed that β-catenin accumulation and translocation were associated with an increase in phosphorylation at Ser552 and decrease phosphorylation at Ser33. Conclusion These findings unveil a potential mechanism for heterotopic ossification in tendinopathy due to the underloading of TDSCs at the damage sites, and also that β-catenin could be a potential target for treating heterotopic ossification in tendons. The Translational potential Tendon heterotopic ossification detrimentally affect quality of life especially for those who has atheletic career. This study reveals the possible mechanism of heterotpic ossification in tendon related to mechanical loading. This study provided the possible to develop a mechanical stimulation protocol for preventive and therapeutic purpose for tendon heterotopic ossification.
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Affiliation(s)
- Tao Wang
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.,Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Peilin Chen
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Lianzhi Chen
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Yinghong Zhou
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Allan Wang
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Qiujian Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Christopher A Mitchell
- Centre for Orthopaedic Translational Research, School of Biomedical Sciences, University of Western Australia, Nedlands, Australia
| | - Toby Leys
- Sir Charles Gairdner Hospital, Perth, Australia
| | - Rocky S Tuan
- Institute for Tissue Engineering and Regenerative Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Ming H Zheng
- Division of Orthopaedic Surgery, Department of Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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19
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Choi KH, Park SG, Baek JH, Lee W, Chang MC. Myositis ossificans causing ulnar neuropathy: a case report. J Int Med Res 2021; 49:3000605211002680. [PMID: 33771066 PMCID: PMC8166390 DOI: 10.1177/03000605211002680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Myositis ossificans (MO) can compress peripheral nerves and cause neuropathy. We herein describe a patient with ulnar neuropathy caused by MO at the medial elbow. A 28-year-old man with a drowsy mentality and multiple organ damage following a traffic accident was admitted to our hospital. After 3 weeks of postoperative care, the patient’s mental status recovered. However, he complained of severe sharp pain in his left medial forearm and fourth and fifth fingers. He exhibited weak fifth finger abduction and wrist adduction. Severe elbow joint pain was elicited during range-of-motion testing of his left elbow. Ultrasound also showed an edematous, enlarged, hypoechoic ulnar nerve lying above the MO, and the MO outwardly displaced the ulnar nerve. Elbow radiographic examination, computed tomography, and magnetic resonance imaging revealed MO development and compression of the left ulnar nerve. The patient underwent surgery; the following day, his left medial forearm pain completely disappeared with slight improvement in the motor weakness of fifth finger abduction. Ultrasound is a useful tool to easily evaluate the presence of MO and compression of peripheral nerves caused by MO.
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Affiliation(s)
- Kyu Hwan Choi
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Sam-Guk Park
- Department of Orthopaedic Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jong Hyun Baek
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Wonho Lee
- Department of Radiology, Topspine Hospital, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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20
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Pătru S, Pădureanu V, Rădulescu D, Mititelu RR, Pădureanu R, Băcanoiu M, Matei D. A nontraumatic myositis ossificans case of the forearm: Case report and literature review. Exp Ther Med 2021; 21:531. [PMID: 33815604 PMCID: PMC8014871 DOI: 10.3892/etm.2021.9963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Myositis ossificans (MO) is a rare, benign ossifying lesion characterized by focal formation of heterotopic bone and cartilage in extraskeletal soft-tissue that most commonly occurs in young adults. In most cases, no causative factor can be identified. The diagnosis of MO is usually based on the patient's history of trauma, clinical signs, on imaging appearance and histological examination. We present a non-traumatic MO case of the forearm in a 40-year-old man with weakness in left finger motion, a decrease in prehension for more than three weeks, without any weight loss, malaise, anorexia or fever. The clinical symptoms and radiological findings can be easily confused with malignant lesions. Treatment is usually conservative but, due to the limited strength and range of motion of the left hand, the tumor was extirpated and the diagnosis of MO was made by biopsy. The patient had no neurological deficits after surgical treatment and was discharged on the fifth day after the surgery in good condition with the recommendation to begin a rehabilitation program.
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Affiliation(s)
- Simona Pătru
- Department of Physical and Rehabilitation Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Dumitru Rădulescu
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Radu Răzvan Mititelu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Rodica Pădureanu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
| | - Manuela Băcanoiu
- Department of Physical Therapy and Sports Medicine, University of Craiova, Craiova 200207, Romania
| | - Daniela Matei
- Department of Physical and Rehabilitation Medicine, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
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21
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Hammad Y, Akiely R, Hajjaj N, Tahboub F, Al-Ajlouni J. The Surgical Management of the Rare Neurogenic Myositis Ossificans of the Hip: A Report of 3 Cases. J Orthop Case Rep 2021; 11:45-51. [PMID: 34239827 PMCID: PMC8241266 DOI: 10.13107/jocr.2021.v11.i03.2082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Myositis ossificans (MO) is a benign non-neoplastic condition in which heterotopic bone formation occurs in soft tissues. Neurogenic MO is one variant of MO where the lesion is a result of neurological disorders, including brain and spinal cord injuries, especially when followed by immobility and spasticity. MO can also be a result of direct trauma or even genetic mutations. Case Report: We present three cases of young men (16, 37, and 22-year-old) who developed MO of the hip joint following brain or spinal cord injuries. One of them had also sustained a direct trauma to the affected hip joint at the time of the accident. All three patients presented with inability to walk independently due to diminished range of motion at the affected joint. X-rays and computerized tomography (CT) scans with 3-dimentional (3D) reconstruction suggested the diagnosis of MO, but the serum alkaline phosphatase was within normal limits at the time of presentation. The first case had bilateral involvement with unmistakable separation between the heterotopic bone formation and the frank hip joints on CT. This patient underwent successful staged excision of the ossifications. The second patient had unilateral hip joint involvement with the absence of clear separation between the heterotopic bone formation and the hip joint, thus, underwent total hip replacement for the affected side as excision was not possible. The third patienthad unilateral hip joint involvement and underwent excision of the ossification with dynamic hip screw insertion after sustaining a stable intertrochanteric fracture intraoperatively. Postoperatively, all three patients received physiotherapy and oral indomethacin. Upon recovery, they were able to walk independently with a near-normal range of motion at the hip joint. There was no evidence of recurrence upon follow-up visits, and CT scans in patients I and II. Follow-ups for patient III were not possible as the patient died 1 month after surgery due to pulmonary embolism. Conclusion: The surgical management of MO is indicated when non-operative methods fail to provide an adequate range of motion around the hip joint. Pre-operative assessment utilizing 3D-CT scans proved to be essential in dictating the appropriate surgical approach. During post-operative follow-ups, the physiotherapy and oral indomethacin provided additional improvement in outcome and patients’ satisfaction.
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Affiliation(s)
- Yazan Hammad
- Department of Orthopaedic Surgery, Jordan University Hospitals, Amman, Jordan
| | - Reem Akiely
- Department of Orthopedic surgery School of Medicine, The University of Jordan, Amman, Jordan
| | - Nada Hajjaj
- Department of Orthopedic surgery School of Medicine, The University of Jordan, Amman, Jordan
| | - Farah Tahboub
- Department of Orthopedic surgery School of Medicine, The University of Jordan, Amman, Jordan
| | - Jihad Al-Ajlouni
- Department of Orthopaedic Surgery, Jordan University Hospitals, Amman, Jordan
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22
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Mu X, Lin CY, Hambright WS, Tang Y, Ravuri S, Lu A, Matre P, Chen W, Gao X, Cui Y, Zhong L, Wang B, Huard J. Aberrant RhoA activation in macrophages increases senescence-associated secretory phenotypes and ectopic calcification in muscular dystrophic mice. Aging (Albany NY) 2020; 12:24853-24871. [PMID: 33361519 PMCID: PMC7803538 DOI: 10.18632/aging.202413] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/21/2020] [Indexed: 12/17/2022]
Abstract
Duchenne Muscular Dystrophy (DMD) patients often suffer from both muscle wasting and osteoporosis. Our previous studies have revealed reduced regeneration potential in skeletal muscle and bone, concomitant with ectopic calcification of soft tissues in double knockout (dKO, dystrophin-/-; utrophin-/-) mice, a severe murine model for DMD. We found significant involvement of RhoA/ROCK (Rho-Associated Protein Kinase) signaling in mediating ectopic calcification of muscles in dKO mice. However, the cellular identity of these RhoA+ cells, and the role that RhoA plays in the chronic inflammation-associated pathologies has not been elucidated. Here, we report that CD68+ macrophages are highly prevalent at the sites of ectopic calcification of dKO mice, and that these macrophages highly express RhoA. Macrophages from dKO mice feature a shift towards a more pro-inflammatory M1 polarization and an increased expression of various senescence-associated secretory phenotype (SASP) factors that was reduced with the RhoA/ROCK inhibitor Y-27632. Further, systemic inhibition of RhoA activity in dKO mice led to reduced number of RhoA+/CD68+ cells, as well as a reduction in fibrosis and ectopic calcification. Together, these data revealed that RhoA signaling may be a key regulator of imbalanced mineralization in the dystrophic musculoskeletal system and consequently a therapeutic target for the treatment of DMD or other related muscle dystrophies.
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Affiliation(s)
- Xiaodong Mu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.,Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
| | - Chi-Yi Lin
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - William S Hambright
- Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
| | - Ying Tang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Sudheer Ravuri
- Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
| | - Aiping Lu
- Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
| | - Polina Matre
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Wanqun Chen
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA.,Department of Biochemistry and Molecular Biology, Jinan University, Guangzhou, China
| | - Xueqin Gao
- Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
| | - Yan Cui
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Ling Zhong
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Bing Wang
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Johnny Huard
- Steadman Philippon Research Institute, Center for Regenerative Sports Medicine, Vail, CO 81657, USA
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23
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Wong KR, Mychasiuk R, O'Brien TJ, Shultz SR, McDonald SJ, Brady RD. Neurological heterotopic ossification: novel mechanisms, prognostic biomarkers and prophylactic therapies. Bone Res 2020; 8:42. [PMID: 33298867 PMCID: PMC7725771 DOI: 10.1038/s41413-020-00119-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/20/2020] [Accepted: 09/16/2020] [Indexed: 02/07/2023] Open
Abstract
Neurological heterotopic ossification (NHO) is a debilitating condition where bone forms in soft tissue, such as muscle surrounding the hip and knee, following an injury to the brain or spinal cord. This abnormal formation of bone can result in nerve impingement, pain, contractures and impaired movement. Patients are often diagnosed with NHO after the bone tissue has completely mineralised, leaving invasive surgical resection the only remaining treatment option. Surgical resection of NHO creates potential for added complications, particularly in patients with concomitant injury to the central nervous system (CNS). Although recent work has begun to shed light on the physiological mechanisms involved in NHO, there remains a significant knowledge gap related to the prognostic biomarkers and prophylactic treatments which are necessary to prevent NHO and optimise patient outcomes. This article reviews the current understanding pertaining to NHO epidemiology, pathobiology, biomarkers and treatment options. In particular, we focus on how concomitant CNS injury may drive ectopic bone formation and discuss considerations for treating polytrauma patients with NHO. We conclude that understanding of the pathogenesis of NHO is rapidly advancing, and as such, there is the strong potential for future research to unearth methods capable of identifying patients likely to develop NHO, and targeted treatments to prevent its manifestation.
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Affiliation(s)
- Ker Rui Wong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Stuart J McDonald
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Bundoora, VIC, Australia
| | - Rhys D Brady
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC, Australia. .,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
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Cai W, Xie Y, Su Y. Comparison of non-surgical and surgical treatment using absorbable screws in anterior-superior iliac spine avulsion fractures with over 1.5cm displacement. Orthop Traumatol Surg Res 2020; 106:1299-1304. [PMID: 32409270 DOI: 10.1016/j.otsr.2020.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/22/2020] [Accepted: 02/28/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is some debate over the best treatment for anterior-superior iliac spine (ASIS) avulsion fractures, although non-surgical treatment can achieve the same results as open surgery. HYPOTHESIS Absorbable screws can be safely used for ASIS avulsion fractures in children and adolescents. AIM OF THE STUDY Here, we compared patients on whom no surgery was performed with those who underwent open surgery and investigated the feasibility of using absorbable screws as a new fixation material for treating ASIS avulsion fractures in children and adolescents. PATIENTS AND METHODS We retrospectively analyzed the data of 59 patients diagnosed with ASIS avulsion fractures in our hospital between January 2009 and December 2016. Based on the clinical data, these patients were assigned into group A (non-surgical group) and group B (absorbable screws group). After the inclusion and exclusion criteria were applied, patients' clinical records, including radiographs, were analyzed. All patients were assessed for range of motion (ROM) and by X-ray as they returned to activity. Evaluation of hip function was done by calculating the American Academy of Orthopedic Surgeons (AAOS) lower limb and hip scores. RESULTS According to AAOS scores, there were significant differences between the two groups at the first and third months postoperatively (p=0.003), but by the sixth and twelfth months, there was no significant difference (p=0.42). Significant differences were also observed between both groups regarding callus growth on radiographs, time to resume sporting activities, and occurrence of complications such as meralgia paresthetica. All complications resolved by 6 months follow-up. CONCLUSION Our study agrees with previous reports, absorbable screws can be safely used for ASIS avulsion fractures with greater than 1.5cm displacement in children and adolescents. In comparison with non-surgical therapy, our results indicate that absorbable screws are associated with shorter recovery time and lesser early complications. LEVEL OF EVIDENCE IV, retrospective study with control group.
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Affiliation(s)
- Wenquan Cai
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, 400014 Chongqing, China
| | - Yan Xie
- Clinical Laboratory Department, Maternal and Child Health Care Hospital of Chongqing Yubei District, Chongqing, China
| | - Yuxi Su
- Department II of Orthopaedics, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, the Children's Hospital of Chongqing Medical University, Yuzhong District Zhongshan 2road 136#, 400014 Chongqing, China.
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25
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Nieuwenhuizen CJ, van Veldhoven PLJ, van Oosterom RF. Rare case of a traumatic myositis ossificans in the tibialis anterior muscle. BMJ Case Rep 2020; 13:13/8/e233210. [PMID: 32816878 DOI: 10.1136/bcr-2019-233210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Athletes involved in contact sports can be diagnosed with traumatic myositis ossificans. Myositis ossificans is characterised by a benign ossifying lesion in soft tissue mass, most commonly preceded by a muscle contusion in the thigh. Despite the fact that it is often a self-limiting disease, treatment modalities are anti-inflammatory drugs, physiotherapy, shockwave therapy, radiation therapy or surgical resection. We report a 22-year-old competitive football player with severe ongoing pain in the lower leg after a direct trauma. An X-ray showed calcification between the tibia and fibula. An additional ultrasound confirmed the diagnosis: myositis ossificans of the tibialis anterior muscle. After treating him with anti-inflammatory drugs and physiotherapy, he was able to return to sports. Myositis ossificans of the lower leg is an uncommon, though if present, troublesome condition, occurring after a contusion.
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Affiliation(s)
| | | | - Robert F van Oosterom
- Sports Medicine, Medisch Centrum Haaglanden, Den Haag, Zuid-Holland, The Netherlands
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26
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Rosenberg DM, Onderdonk B, Majeed NK, Guzman G, Farid Y, Connell PP, Son CH. Radiation-Induced Sarcoma After Heterotopic Ossification Prophylaxis: A Case Report. JBJS Case Connect 2020; 9:e0146. [PMID: 31815809 DOI: 10.2106/jbjs.cc.19.00146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
CASE Heterotopic ossification (HO) is a pathological formation of bone in nonosseous tissue and is a common complication of orthopaedic procedures. Radiotherapy is often used to prevent HO despite the small risk of secondary malignancy. Here, we report a case of a patient who developed a periprosthetic, radiation-induced sarcoma after delivery of a single fraction of 7 Gy for HO prophylaxis. This sarcoma was found to lie entirely within the treatment field and occurred within 5 years of radiation. CONCLUSION Appropriate counseling regarding radiation-induced sarcoma formation should be provided to patients considering radiotherapy for this HO prophylaxis.
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Affiliation(s)
- David M Rosenberg
- College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Benjamin Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Nasma K Majeed
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Grace Guzman
- Department of Pathology, University of Illinois at Chicago, Chicago, Illinois
| | - Yasser Farid
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Philip P Connell
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Christina H Son
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois.,Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois
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27
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Post-stroke bilateral heterotopic ossification: An acute problem with long-lasting consequences. Jt Dis Relat Surg 2020; 31:386-389. [PMID: 32584742 PMCID: PMC7489164 DOI: 10.5606/ehc.2020.72081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/05/2020] [Indexed: 11/21/2022] Open
Abstract
Heterotopic ossification (HO) is a complication of injury to the central nervous system in which production of lamellar bone within the soft tissues occurs resulting in pain, reduced range of motion (ROM) and loss of functional capacity. Heterotopic ossification is rarely seen in stroke patients and mostly affects the paretic side. In this article, we present a case of established bilateral HO of the hips soon after stroke onset. A 77-year-old female patient with a five-month history of stroke presented to our rehabilitation clinic. Physical examination revealed sensorimotor aphasia, right-sided hemiplegia, bilateral painful limited ROM of the hips and left knee contracture. An anteroposterior X-ray of the pelvis revealed previously undiagnosed bilateral HO of the hips. The patient and her relatives declined operative interventions. The patient was discussed in the departmental meeting and it was agreed that she would not be able to partake in an active inpatient rehabilitation program. She was discharged with a home exercise plan. This case highlights the importance of HO, of both the paretic and non-paretic side, being included in the differential diagnosis of post-stroke patients presenting with joint pain and reduced ROM, both acutely and in the long-term. This may aid the timely diagnosis and management of HO, a pathology which has detrimental effects on functionality.
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28
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Lespasio MJ, Guarino AJ. Awareness of Heterotopic Ossification in Total Joint Arthroplasty: A Primer. Perm J 2020; 24:19.211. [PMID: 32069212 DOI: 10.7812/tpp/19.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Heterotopic ossification (HO) is the presence of normal bone in soft tissue where bone should not exist. After direct musculoskeletal trauma of the surrounding soft tissue, HO is hypothesized to develop from a dysfunction of normal lamellar bone formation and remodeling that appears in nonskeletal areas of the body. Acquired HO related to total joint arthroplasty (TJA) of the hip and knee forms outside the joint capsule and can be a challenging condition when it impairs the essential healing process after elective surgery. Although HO is rare after elective TJA and thus clinically immaterial, when clinically relevant HO develops, patients may experience the following: 1) limited ambulation, 2) restricted range of motion, and 3) severe pain and discomfort that may lead to loss of function. Ultimately, patients with clinically relevant HO after elective TJA may require additional treatment, including medication, radiation therapy, manipulation under anesthesia, surgical excision of the HO, and possibly revision TJA. Awareness of HO and an understanding of the associated risk factors along with the various management options will enable health care practitioners and their patients to optimize their surgical outcomes.
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29
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Huang CW, Tang CL, Pan HC, Tzeng CY, Tsou HK. Severe heterotopic ossification in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty: A case report. World J Clin Cases 2019; 7:3047-3054. [PMID: 31624753 PMCID: PMC6795720 DOI: 10.12998/wjcc.v7.i19.3047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/20/2019] [Accepted: 08/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical disc arthroplasty (CDA) is an alternative treatment to traditional interbody fusion that maintains postoperative cervical spine mobility. However, the CDA postoperative period is impacted by osteolysis, subsidence, metallosis, or heterotopic ossification (HO). We report a case of severe HO in a seronegative spondyloarthritis patient after cervical Bryan disc arthroplasty.
CASE SUMMARY A 34-year-old man received hybrid surgery for C4-C5 and C5-C6 arthroplasty with Bryan discs and C6-C7 arthrodesis with polyetheretherketone cage due to traumatic herniation of the intervertebral disc (HIVD). After four years, cervical spine radiographs revealed severe HO around the Bryan discs over the C4-C5 and C5-C6 levels. The magnetic resonance image revealed HIVD over the C3-C4 level with spinal cord compression. Seronegative spondyloarthritis was diagnosed after consultation with a rheumatologist. A second CDA for the adjacent segment disease HIVD with Baguera C disc over the C3-C4 level achieved an excellent outcome.
CONCLUSION Minimizing intraoperative tissue trauma and achieving postoperative interbody stability avoid soft tissue traction to prevent HO formation after CDA.
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Affiliation(s)
- Chih-Wei Huang
- Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chien-Lun Tang
- Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Hung-Chuan Pan
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Chung-Yuh Tzeng
- Division of Joint Reconstruction, Department of Orthopedics, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County 515, Taiwan
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 356, Taiwan
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30
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Heterotopic ossification: radiological and pathological review. Radiol Oncol 2019; 53:275-284. [PMID: 31553710 PMCID: PMC6765162 DOI: 10.2478/raon-2019-0039] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Heterotopic Ossification (HO) is a common condition referring to ectopic bone formation in soft tissues. It has two major etiologies, acquired (more common) and genetic. The acquired form is closely related to tissue trauma. The exact pathogenesis of this disease remains unclear; however, there is ongoing research in prophylactic and therapeutic treatments that is promising. Conclusions Due to HO potential to cause disability, it is so important to differentiate it from other causes in order to establish the best possible management.
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31
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Meyers C, Lisiecki J, Miller S, Levin A, Fayad L, Ding C, Sono T, McCarthy E, Levi B, James AW. Heterotopic Ossification: A Comprehensive Review. JBMR Plus 2019; 3:e10172. [PMID: 31044187 PMCID: PMC6478587 DOI: 10.1002/jbm4.10172] [Citation(s) in RCA: 239] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/31/2018] [Accepted: 01/13/2019] [Indexed: 12/17/2022] Open
Abstract
Heterotopic ossification (HO) is a diverse pathologic process, defined as the formation of extraskeletal bone in muscle and soft tissues. HO can be conceptualized as a tissue repair process gone awry and is a common complication of trauma and surgery. This comprehensive review seeks to synthesize the clinical, pathoetiologic, and basic biologic features of HO, including nongenetic and genetic forms. First, the clinical features, radiographic appearance, histopathologic diagnosis, and current methods of treatment are discussed. Next, current concepts regarding the mechanistic bases for HO are discussed, including the putative cell types responsible for HO formation, the inflammatory milieu and other prerequisite “niche” factors for HO initiation and propagation, and currently available animal models for the study of HO of this common and potentially devastating condition. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Carolyn Meyers
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | | | - Sarah Miller
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Adam Levin
- Department of Orthopaedic Surgery Johns Hopkins University Baltimore MD USA
| | - Laura Fayad
- Department of Radiology Johns Hopkins University Baltimore MD USA
| | - Catherine Ding
- UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center Los Angeles CA USA
| | - Takashi Sono
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Edward McCarthy
- Department of Pathology Johns Hopkins University Baltimore MD USA
| | - Benjamin Levi
- Department of Surgery University of Michigan Ann Arbor MI USA
| | - Aaron W James
- Department of Pathology Johns Hopkins University Baltimore MD USA.,UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery and the Orthopaedic Hospital Research Center Los Angeles CA USA
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32
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An T, Garlich J, Kulber D. Yoga-Induced Myositis Ossificans Traumatica of the Scapholunate Ligament. J Wrist Surg 2019; 8:80-83. [PMID: 30723608 PMCID: PMC6358443 DOI: 10.1055/s-0038-1661354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/21/2018] [Indexed: 10/28/2022]
Abstract
Background Myositis ossificans traumatica (MOT) involves the heterotopic development of lamellar bone after a traumatic injury. Despite being termed "myositis," MOT is not limited to muscle but rather can involve tendons, fat, and fascia. "Traumatica" reflects that lesions are usually associated with a history of significant trauma, that is, fractures or surgery; however, many reports suggest they can also be linked to repetitive low-energy insults. In both cases, the inflammatory response secondary to tissue injury generates a proliferative osteoblastic cascade. Case Description We present a case of persistent wrist pain in a 43-year-old woman associated with yoga activities. Her radiographic studies demonstrated partial scapholunate (SL) ligament tear and an associated mass lesion. Surgical pathology revealed MOT involving the SL ligament. Literature Review MOT lesions in the upper extremity are usually localized around the elbow, and cases in the hand are relatively rare. There are no prior reports of occurrences within the wrist joint or in association with the SL ligament. However, biomechanical studies have quantified significant mechanical strains across the SL interval during various yoga poses. This pattern of microtrauma is capable of generating MOT. Clinical Relevance Upper extremity weight-bearing positions are common in yoga and subject the wrist, especially the SL interval, to high mechanical strains. This pattern of microtrauma should lead the clinician to suspect MOT when encountering a mass in the wrist, but malignancy and infection must be ruled out.
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Affiliation(s)
- Tonya An
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - John Garlich
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
| | - David Kulber
- Department of Orthopaedic Surgery, Cedars Sinai Medical Center, Los Angeles, California
- Beverly Hills Hand and Plastic Reconstructive Surgery, Los Angeles, California
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Abstract
INTRODUCTION Posttraumatic heterotopic ossification (HO) of the hip frequently follows acetabular fracture and hip surgery and can become symptomatic, with significant pain and limited range of motion (ROM). Definitive treatment may require surgical excision, which can result in serious complications if not planned and executed appropriately. METHODS Surgical excision of posttraumatic hip HO requires appropriate indications, preoperative planning, and intraoperative guidance using fluoroscopy to maximize excision of HO and minimize complications. This video presents a case of severe posttraumatic hip HO, indications and technique of surgical excision using fluoroscopic guidance, postoperative protocol, and the patient's clinical follow-up. RESULTS Surgical excision along with appropriate postoperative HO prophylaxis and immediate mobilization resulted in significant improvement in hip ROM and return to activities of daily living without complications or recurrence. Intraoperative blood loss can be significant and should be appropriately planned for preoperatively. CONCLUSIONS Posttraumatic hip HO can cause significantly limited hip ROM and pain with resulting disability. Surgical excision of posttraumatic hip HO in a preserved hip joint can be successful in restoring hip ROM and function. Appropriate postoperative HO prophylaxis can prevent recurrence.
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Abstract
The hip is a common location for heterotopic ossification after surgical trauma, blunt trauma, or muscle injury. However, the region around the pubic rami is an unusual location for heterotopic bone formation. Here, we present a case of a young, active man in the Armed Forces Reserve with a large heterotopic bone involving the left inferior pubic ramus who underwent surgical excision through an unusual approach via the perineum. The patient had notable pain relief postoperatively and returned to his active duties 1 month after surgery without discomfort or functional limitation.
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35
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Pohlodek K, Janík M, Mečiarová I, Ondriaš F. Pseudomalignant myositis ossificans in the breast: A case report. Mol Clin Oncol 2018; 8:749-752. [PMID: 29844904 DOI: 10.3892/mco.2018.1609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/22/2018] [Indexed: 12/27/2022] Open
Abstract
Myositis ossificans (MO) is characterized by abnormal heterotopic ossification formation, typically involving muscles, tendons, ligaments, fascia, and aponeurosis. It can be categorized into nonhereditary and hereditary types, with the latter being a distinct entity with a separate pathophysiology and treatment approach. The pathophysiology of MO formation remains to be fully elucidated. MO is most commonly observed in muscle tissue as a solitary lesion. The disease has been reported to occur in all ages, including the very young and in atypical locations, including hands, feet, ribs, head and neck. The present case report describes an unusual pseudomalignant form of MO in the breast. The authors discuss the clinical and morphological characteristics of the tumor and its treatment options.
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Affiliation(s)
- Kamil Pohlodek
- Second Department of Gynecology and Obstetrics, Comenius University of Bratislava, Faculty of Medicine, 82606 Bratislava, Slovakia
| | - Miroslav Janík
- Department of Thoracic Surgery, Slovak Medical University of Bratislava, 82606 Bratislava, Slovakia
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36
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Affiliation(s)
- Allen W. Root
- Department of Pediatrics, Johns Hopkins Medicine – All Children’s Hospital, St. Petersburg, FL, USA
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37
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Martin EC, Qureshi AT, Llamas CB, Boos EC, King AG, Krause PC, Lee OC, Dasa V, Freitas MA, Forsberg JA, Elster EA, Davis TA, Gimble JM. Trauma induced heterotopic ossification patient serum alters mitogen activated protein kinase signaling in adipose stem cells. J Cell Physiol 2018; 233:7035-7044. [PMID: 29377109 DOI: 10.1002/jcp.26504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/24/2018] [Indexed: 12/15/2022]
Abstract
Post-traumatic heterotopic ossification (HO) is the formation of ectopic bone in non-osseous structures following injury. The precise mechanism for bone development following trauma is unknown; however, early onset of HO may involve the production of pro-osteogenic serum factors. Here we evaluated serum from a cohort of civilian and military patients post trauma to determine early induction gene signatures in orthopaedic trauma induced HO. To test this, human adipose derived stromal/stem cells (hASCs) were stimulated with human serum from patients who developed HO following trauma and evaluated for a gene panel with qPCR. Pathway gene analysis ontology revealed that hASCs stimulated with serum from patients who developed HO had altered gene expression in the activator protein 1 (AP1) and AP1 transcriptional targets pathways. Notably, there was a significant repression in FOS gene expression in hASCs treated with serum from individuals with HO. Furthermore, the mitogen-activated protein kinase (MAPK) signaling pathway was activated in hASCs following serum exposure from individuals with HO. Serum from both military and civilian patients with trauma induced HO had elevated downstream genes associated with the MAPK pathways. Stimulation of hASCs with known regulators of osteogenesis (BMP2, IL6, Forskolin, and WNT3A) failed to recapitulate the gene signature observed in hASCs following serum stimulation, suggesting non-canonical mechanisms for gene regulation in trauma induced HO. These findings provide new insight for the development of HO and support ongoing work linking the systemic response to injury with wound specific outcomes.
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Affiliation(s)
- Elizabeth C Martin
- Department of Biological and Agricultural Engineering, Louisiana State University, Baton Rouge, Louisiana
| | - Ammar T Qureshi
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland
| | - Claire B Llamas
- Tulane University School of Medicine, Center for Stem Cell Research and Regenerative Medicine, New Orleans, Louisiana
| | - Elaine C Boos
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Andrew G King
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Peter C Krause
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Olivia C Lee
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Vinod Dasa
- Department of Orthopaedics, Louisiana State University Health Science Center, New Orleans, Louisiana
| | - Michael A Freitas
- Department of Cancer Biology and Genetics, Ohio State University, Columbus, Ohio
| | - Jonathan A Forsberg
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thomas A Davis
- Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, Maryland.,Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, Maryland
| | - J M Gimble
- Tulane University School of Medicine, Center for Stem Cell Research and Regenerative Medicine, New Orleans, Louisiana.,Departments of Medicine, Structural and Cellular Biology, & Surgery, Tulane University School of Medicine, New Orleans, Louisiana.,LaCell LLC, New Orleans, Louisiana
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38
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Wang X, Li F, Xie L, Crane J, Zhen G, Mishina Y, Deng R, Gao B, Chen H, Liu S, Yang P, Gao M, Tu M, Wang Y, Wan M, Fan C, Cao X. Inhibition of overactive TGF-β attenuates progression of heterotopic ossification in mice. Nat Commun 2018; 9:551. [PMID: 29416028 PMCID: PMC5803194 DOI: 10.1038/s41467-018-02988-5] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 01/11/2018] [Indexed: 12/24/2022] Open
Abstract
Acquired heterotopic ossification (HO) is a painful and debilitating disease characterized by extraskeletal bone formation after injury. The exact pathogenesis of HO remains unknown. Here we show that TGF-β initiates and promotes HO in mice. We find that calcified cartilage and newly formed bone resorb osteoclasts after onset of HO, which leads to high levels of active TGF-β that recruit mesenchymal stromal/progenitor cells (MSPCs) in the HO microenvironment. Transgenic expression of active TGF-β in tendon induces spontaneous HO, whereas systemic injection of a TGF-β neutralizing antibody attenuates ectopic bone formation in traumatic and BMP-induced mouse HO models, and in a fibrodysplasia ossificans progressive mouse model. Moreover, inducible knockout of the TGF-β type II receptor in MSPCs inhibits HO progression in HO mouse models. Our study points toward elevated levels of active TGF-β as inducers and promoters of ectopic bone formation, and suggest that TGF-β might be a therapeutic target in HO.
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MESH Headings
- Achilles Tendon/drug effects
- Achilles Tendon/injuries
- Adult
- Animals
- Antibodies, Neutralizing/pharmacology
- Becaplermin/metabolism
- Bone Remodeling
- Brain Injuries, Traumatic
- Cartilage
- Case-Control Studies
- Disease Models, Animal
- Elbow Joint/surgery
- Female
- Fracture Fixation, Internal
- Fractures, Bone
- Humans
- Male
- Mesenchymal Stem Cells/metabolism
- Mice
- Mice, Knockout
- Mice, Transgenic
- Middle Aged
- Muscle, Skeletal/pathology
- Myositis Ossificans/metabolism
- Ossification, Heterotopic/metabolism
- Osteoclasts
- Osteogenesis/drug effects
- Receptor, Transforming Growth Factor-beta Type II/genetics
- Spinal Cord Injuries
- Tendon Injuries
- Tendons
- Transforming Growth Factor beta/antagonists & inhibitors
- Transforming Growth Factor beta/metabolism
- Transforming Growth Factor beta1/metabolism
- Young Adult
- Elbow Injuries
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Affiliation(s)
- Xiao Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Fengfeng Li
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Liang Xie
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Janet Crane
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Gehua Zhen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yuji Mishina
- School of Dentistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Ruoxian Deng
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Bo Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Hao Chen
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Shen Liu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Ping Yang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manman Gao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Manli Tu
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Yiguo Wang
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cunyi Fan
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital, 200030, Shanghai, China
| | - Xu Cao
- Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Our objective was to examine the prevalence, clinical significance, ramifications, and possible etiology of postoperative bone formation at the index level after cervical disc replacement (CDR) with a minimum of 5 years of follow-up. SUMMARY OF BACKGROUND DATA CDR can be complicated by postoperative ossification and unwanted ankylosis at the index level, which some authors have termed "heterotopic ossification." This terminology may be inaccurate as it assumes the postoperative bone formation is unnatural and a consequence of the CDR surgery. We advocate that this phenomenon has more to do with individual patient factors rather than the surgery. METHODS Patients who underwent Bryan CDR for cervical myelopathy or radiculopathy between 12/2003 and 8/2008 with a minimum of 5-years follow-up were analyzed. They were divided into two groups, those with and without postoperative bone formation. Patient-reported outcomes (Japanese Orthopaedic Association score, Neck Disability Index, Visual Analogue Scale for neck and arm pain) and radiographic parameters were collected pre- and postoperatively and compared between groups. RESULTS Sixty-one patients (76 levels) were identified (mean follow-up 94.2 mo). The overall incidence of postoperative ossification was 50%. Both groups had sustained significant improvements across all patient-reported outcome measures at final follow-up. Notably, patients with more severe preoperative cervical spondylosis had higher rates of postoperative ossification (P = 0.036) and adjacent segment degeneration (P = 0.010). CONCLUSION Although the long-term incidence of postoperative bone formation after CDR was relatively high, this did not adversely affect patient outcomes. Patients with more severe preoperative spondylosis had higher rates of postoperative ossification, suggesting that postoperative ossification at the CDR segment is likely one of progressive bone formation in individuals already predisposed to forming bone rather than one of alleged heterotopic ossification as a consequence of the surgery. LEVEL OF EVIDENCE 3.
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Hintze JM, O'Hare K, McDermott T, Thomas AZ. Paratesticular myositis ossificans of the spermatic cord. BMJ Case Rep 2018; 2018:bcr-2017-223178. [PMID: 29301813 DOI: 10.1136/bcr-2017-223178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old man presented with a painless scrotal lump, enlarging over the preceding 1 month. The lump was roughly 1 cm in size, and located in his left hemiscrotum and separate from the testis. An ultrasound revealed an echogenic focus with dystrophic tissue calcification. Subsequent surgical excision and histopathological analysis revealed it to be late-stage myositis ossificans, a benign, extraosseous formation of the bone or cartilage. We report of only the second described case of myositis ossificans of the spermatic cord in the literature to date.
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Affiliation(s)
- Justin M Hintze
- Department of Urology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Kevin O'Hare
- Department of Cellular Pathology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Ted McDermott
- Department of Urology, Adelaide and Meath Hospital, Dublin, Ireland
| | - Arun Z Thomas
- Department of Urology, Adelaide and Meath Hospital, Dublin, Ireland
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Oxidative stress in ageing and disease development studied by FT-IR spectroscopy. Mech Ageing Dev 2017; 172:107-114. [PMID: 29113732 DOI: 10.1016/j.mad.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/31/2017] [Accepted: 11/01/2017] [Indexed: 11/21/2022]
Abstract
FT-IR spectroscopy was used to investigate the effect of oxidative stress and to approach the mechanism on cancer bone demineralization, aortic valve mineralization and heterotopic ossification on disease development. The FT-IR spectra obtained from paediatric, adult bone and ex vivo irradiated adult healthy bone with a dose of 20Gy were compared with those of healthy bone. The increase of band intensity changes of vasCH2,vsCH2 in the region 3000-2850cm-1 depended on aging, the disease progression and the dose of irradiation. The bands at 3080cm-1 and 1744cm-1, which originate from olefinic terminal bond (v=CH) and ester carbonyl group (vROCO), respectively, indicate the influence of oxidative stress on lipid degradation and peroxidation, respectively. The new bands at about 1690cm-1 and 1516cm-1 denote the presence of β-sheet conformation of the proteins due to the diseases, confirming the increasing amount of lipophilic environment and fibril formation. Comparison of the FT-IR spectra of calcified aortic valve and hip heterotopic ossification with that of normal bones showed that in the bone-like formation the peroxide anion free radicals play an important role in the disease.
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MacLeod AM, Treuting PM, Carlson CS. Proliferative Cartilaginous Lesions in the Calcaneal Tendons of huNOG Mice. Toxicol Pathol 2017; 45:952-956. [PMID: 28974149 DOI: 10.1177/0192623317734822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
NOD/Shi-scid/IL-2Rγnull (NOG) mice are humanized with CD34+ hematopoietic cells (huNOG mice) and are commonly utilized for biological or medical research on human therapeutics. In the present study, nine 26-week-old, female huNOG mice were utilized for testing proprietary immune-modulating drugs over a 3-week period at the University of Washington. Two of the 9 mice developed unilateral swelling of a tibiotarsal joint with associated paresis of the affected limb. Full necropsies were performed after euthanasia at experimental end point, and routine tissues and affected tibiotarsal joints were evaluated. An expansile, multilobular mass composed primarily of chondroid cells associated with the calcaneal tendon was present within 1 tibiotarsal joint of both mice. A small focus of well-differentiated bone was present within the mass of 1 mouse. In addition, the calcaneal periosteum was expanded by a chondroid mass in 1 mouse. The cartilaginous masses associated with the calcaneal tendon were interpreted as a hyperplastic or low-grade neoplastic process accompanied by endochondral ossification, and the mass associated with the calcaneal periosteum was interpreted as chondroid metaplasia. Although the etiology of these lesions is unclear, their prevalence in 2/9 (22%) huNOG mice is interesting and may have biological significance for future studies involving the huNOG mouse model.
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Affiliation(s)
- Alexandria M MacLeod
- 1 College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA.,2 Institute for Animal Pathology, University of Bern, Bern, Switzerland
| | - Piper M Treuting
- 3 Department of Comparative Medicine, University of Washington, Seattle, Washington, USA
| | - Cathy S Carlson
- 1 College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota, USA
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Macheras GA, Lepetsos P, Leonidou A, Anastasopoulos PP, Galanakos SP, Tsiridis E. Results from the surgical resection of severe heterotopic ossification of the hip: a case series of 26 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:1097-1102. [PMID: 28589499 DOI: 10.1007/s00590-017-1980-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Surgical resection of heterotopic ossification (HO) around the hip joint is often challenging. The aim of this study is to evaluate the clinical and radiological outcomes following surgical resection of Brooker's type III and IV HO of the hip. METHODS We retrospectively reviewed clinical and radiological data, between November 2006 and January 2013, of all patients who underwent surgical resection of severe HO of the hip. Brooker's grading, range of motion and the Harris Hip Score before and after surgery were recorded in all cases. The combined radiation (700 cGy preoperatively) and indomethacin regimen was used to prevent heterotopic ossification recurrence. RESULTS Twenty-six patients (22 males and 4 females) were included in our study. Mean patient age was 47.38 years (range 24-72). The HO was graded as Brooker grade III in 3 patients (11.5%) and Brooker grade IV in 23 patients (88.5%). Mean time interval between HO development and resection was 40.8 months (range 13-156 months). All patients had CT scans prior to surgery. Mean follow-up was 31.4 months (range 24-40 months). There was no severe HO recurrence. Complications included one intraoperative injury of a femoral artery branch, one intraoperative femoral neck fracture treated with intramedullary nailing, one sciatic nerve injury and one superficial infection treated conservatively. CONCLUSIONS Surgical resection of severe HO of the hip along with preoperative radiation and indomethacin provides excellent results; however, the complication rate is relatively high. Careful evaluation of the preoperative CT scan and wide exposure are required in order to identify all the involved neurovascular structures.
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Affiliation(s)
- George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
| | - Panagiotis Lepetsos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece.
| | - Andreas Leonidou
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Ring Road, N. Efkarpia, 56403, Thessaloníki, Greece
| | | | - Spyridon P Galanakos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
| | - Eleftherios Tsiridis
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, Ring Road, N. Efkarpia, 56403, Thessaloníki, Greece
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Sferopoulos NK, Kotakidou R, Petropoulos AS. Myositis ossificans in children: a review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:491-502. [DOI: 10.1007/s00590-017-1932-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/16/2017] [Indexed: 12/29/2022]
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Grabski M, Fews D, Busschers E. Hindlimb lameness associated with a focal osseous metaplasia in an 18-year-old Welsh Section D mare. EQUINE VET EDUC 2017. [DOI: 10.1111/eve.12413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M. Grabski
- Department of Clinical Veterinary Sciences; University of Bristol; Bristol UK
| | - D. Fews
- Department of Veterinary Pathology, Infection and Immunity; School of Veterinary Sciences; University of Bristol; Bristol UK
| | - E. Busschers
- Department of Clinical Veterinary Sciences; University of Bristol; Bristol UK
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Rolka Ł, Browiński D, Kwiatek-Rolka K, Sielska M, Sielski G, M. Nyka W. Neurogenic heterotopic ossifi cation – case study. REHABILITACJA MEDYCZNA 2017. [DOI: 10.5604/01.3001.0009.5482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors presented the case of a 30-year-old man in whom sudden cardiac arrest occurred as a result of high voltage electric shock. Starting from the 2nd week after the accident, rehabilitation was carried out in hospital conditions, designed to maintain range of motion in the joints, and from the 6th week, intensive rehabilitation was performed at the patient’s home. Despite the implemented treatment, total mobility restriction was observed in the hip joints, and based on spatial projection radiography and a CT, the patient was diagnosed with massive neurogenic heterotopic ossifi cation (NHO). Two surgeries were performed to remove the NHO: fi rst, from the left area (15th month after the accident), and then the right hip joint (18th month following the accident). After the intervention there was a signifi cant increase in mobility of both hips and a decrease in pain, which resulted in signifi cantly improved functional capabilities of the patient. In addition, prophylaxis to prevent the recurrence of NHO was implemented in order to maintain both passive and active range of motion, and the use of physical therapy treatments in the form of deep oscillation were performed. The results of the CT conducted in the 41st month following the accident revealed lesser NHO than the originally diagnosed.
Rolka Ł., Browiński D., Kwiatek-Rolka K., Sielska M., Sielski G., Nyka W.M. Neurogenic heterotopic ossification – case study. Med Rehabil 2016; 20(4): 22-27. DOI: 10.5604/01.3001.0009.5482
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Affiliation(s)
- Łukasz Rolka
- Clinic of Adult Neurology at the Medical University of Gdańsk, Poland
| | - Daniel Browiński
- Clinic of Adult Neurology at the Medical University of Gdańsk, Poland
| | | | - Małgorzata Sielska
- Department and Chair of Music Therapy at Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Grzegorz Sielski
- Department and Clinic of Geriatrics at Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, Poland
| | - Walenty M. Nyka
- Clinic of Adult Neurology at the Medical University of Gdańsk, Poland
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Papanagiotou M, Dailiana ZH, Karachalios T, Varitimidis S, Hantes M, Dimakopoulos G, Vlychou M, Malizos KN. Heterotopic ossification after the use of recombinant human bone morphogenetic protein-7. World J Orthop 2017; 8:36-41. [PMID: 28144577 PMCID: PMC5241543 DOI: 10.5312/wjo.v8.i1.36] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 08/21/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To present the incidence of heterotopic ossification after the use of recombinant human bone morphogenetic protein-7 (rhBMP-7) for the treatment of nonunions.
METHODS Bone morphogenetic proteins (BMPs) promote bone formation by auto-induction. Recombinant human BMP-7 in combination with bone grafts was used in 84 patients for the treatment of long bone nonunions. All patients were evaluated radiographicaly for the development of heterotopic ossification during the standard assessment for the nonunion healing. In all patients (80.9%) with radiographic signs of heterotopic ossification, a CT scan was performed. Nonunion site palpation and ROM evaluation of the adjacent joints were also carried out. Factors related to the patient (age, gender), the nonunion (location, size, chronicity, number of previous procedures, infection, surrounding tissues condition) and the surgical procedure (graft and fixation type, amount of rhBMP-7) were correlated with the development of heterotopic ossification and statistical analysis with Pearsons χ2 test was performed.
RESULTS Eighty point nine percent of the nonunions treated with rhBMP-7, healed with no need for further procedures. Heterotopic bone formation occurred in 15 of 84 patients (17.8%) and it was apparent in the routine radiological evaluation of the nonunion site, in a mean time of 5.5 mo after the rhBMP-7 application (range 3-12). The heterotopic ossification was located at the femur in 8 cases, at the tibia in 6, and at the humerus in οne patient. In 4 patients a palpable mass was present and only in one patient, with a para-articular knee nonunion treated with rhBMP-7, the size of heterotopic ossification affected the knee range of motion. All the patients with heterotopic ossification were male. Statistical analysis proved that patient’s gender was the only important factor for the development of heterotopic ossification (P = 0.007).
CONCLUSION Heterotopic ossification after the use of rhBMP-7 in nonunions was common but it did not compromise the final clinical outcome in most cases, and affected only male patients.
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Lee CH, Shim SJ, Kim HJ, Yang H, Kang YJ. Effects of Radiation Therapy on Established Neurogenic Heterotopic Ossification. Ann Rehabil Med 2016; 40:1135-1139. [PMID: 28119846 PMCID: PMC5256336 DOI: 10.5535/arm.2016.40.6.1135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/07/2016] [Indexed: 11/05/2022] Open
Abstract
Heterotopic ossification (HO) is frequently seen on rehabilitation units after spinal cord injuries, fractures, brain injuries, and limb amputations. Currently, there is no effective treatment for HO other than prophylaxis with anti-inflammatory medications, irradiation, and bisphosphonate administration. These prophylactic treatments are not effective for managing ectopic bone once it has formed. Here we describe three cases of established neurogenic HO treated with radiation therapy (RT). All patients had decreased serum alkaline phosphatase (ALP) and bone-specific ALP levels with decreased pain but increased range of motion immediately after RT. Post-treatment X-rays revealed no further growth of the HO. All patients maintained clinical and laboratory improvements 4 or 6 months after the RT. Our results suggest that RT is safe and effective in decreasing pain and activity of neurogenic HO.
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Affiliation(s)
- Chan Ho Lee
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Su Jung Shim
- Department of Radiation Oncology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Hyun Jung Kim
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Hyuna Yang
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Youn Joo Kang
- Department of Rehabilitation Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
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Heterotopic ossification following anti-NMDA receptor encephalitis: a case report. BMC Neurol 2016; 16:232. [PMID: 27871317 PMCID: PMC5117503 DOI: 10.1186/s12883-016-0747-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Heterotopic ossification (HO) is defined as the formation of true bone tissue in non-osseous tissues. HO may occur under several conditions such as soft tissue injury, central nervous system injury and many other diseases like arthopathies, and vasculopathies. The underlying mechanisms of HO are not well elucidated. Anti-NMDA receptor encephalitis is a newly recognized autoimmune mediated disease which is predominant in young female patients with ovarian teratomas. Encephalitis complicated with HO has rarely been reported. Case presentation Here we report a case of anti-NMDA receptor encephalitis with severe muscle ossifications. A 15 years old female patient presented with fever, changed mental status of confusion, rigidity of the arms and legs, and oral-facial dyskinesias. Diagnosis of anti-NMDA receptor encephalitis was confirmed by detection of anti-NMDA receptor antibodies both in serum and CSF. Due to the severity of the disease, 3-weeks’ intensive care and mechanical ventilation were administrated for the patient. Image of pelvic CT and MRI of the patient showed dynamic changing process of HO. The muscles showed edema and scattered inflammation at the very beginning, and then gradually formed mature bone tissue. Conclusions Anti-NMDA receptor encephalitis often presents with severe neurologic symptoms and requires long time intensive care and mechanical ventilation, which makes the patient easily complicate with HO. More studies are required to elucidate the mechanisms of HO and more attention should be paid to patients with encephalitis who might develop severe muscle ossifications requiring early interventions.
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van Leeuwen RJH, Kraal T, Scholtens S, Visser G. A large heterotopic ossification in a 25 years old laparotomy scar. Quant Imaging Med Surg 2016; 6:470-473. [PMID: 27709086 DOI: 10.21037/qims.2016.07.05] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Tim Kraal
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Sander Scholtens
- Department of Radiology, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Gijs Visser
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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