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PubMed2001

Ossification in atherosclerotic carotid arteries.

BACKGROUND: Heterotopic ossification as newly formed bone in extraosseous tissue is an uncommon finding in atherosclerotic lesions. The exact mechanisms and development of bone formation in regard to late stage calcified atherosclerosis still remains under debate. METHODS: We studied 400 autopsy carotid probes and 306 samples of atherosclerotic carotid endatherectomy. Radiographic analysis and classification of calcification was performed followed by light microscopy. In probes with detected ossifications further analysis using immunohistochemistry, scanning electron microscopy (SEM) and energy dispersive x-ray micro-analysis (EDX) including calcium mapping was performed. RESULTS: Ossification in atherosclerotic carotid arteries was a finding in only a minority of samples (5%) and occurred at sites of large calcific deposits. Histomorphology of bone formation equaled skeletal bone showing osteoblastic cells, osteocytes included in osteoid matrix, bone marrow and osteolytic giant multinucleated cells. Closely related to newly formed bone zones of neovascularization were found. Development of ossification seemed to occur in five stages (lipidous plaque, fibrous cellular plaque, fibrous acellular plaque, calcified plaque and osteogenesis). The environment of sites of ossification was characterized by a varying texture of extracellular fibrous matrix, foam cells, smooth muscle cells, fibroblasts and calcified deposits. CONCLUSIONS: Heterotopic ossifications of atherosclerotic plaques seem to be a specific differentiation of fibrous plaques. Components of atherosclerotic lesions like vascular wall cells, neovessels and matrix structures seem to be involved in the process of transformation to mature bone tissue.

Arteriosclerosis↗
PubMed1994

Reliability and validity of the grading of heterotopic ossification.

The purpose of this study is to assess the reliability and validity of the Brooker grading of heterotopic ossification. Anteroposterior hip radiographs of 77 patients, taken 6 months following total hip arthroplasty, were blindly evaluated twice by two surgeons using the Brooker scale. Patients were also evaluated with the Harris hip scale, and range of motion of the hip was determined. All inconsistencies in heterotopic ossification grading were reviewed by the same two surgeons who developed six points of clarification to minimize ambiguities in the Brooker grading criteria. A second set of 76 radiographs were reviewed by the two surgeons using this modified Brooker index. The intraobserver reliability of the two readers was good, with agreements of 77 and 86% and weighted kappa values of 0.63 and 0.69, respectively. The two surgeons demonstrated fair interobserver reliability on the first reading (agreement of 68% and weighted kappa of 0.57) that improved to a good level of reliability (agreement of 77% and weighted kappa of 0.68) using the revised Brooker index. The grade of heterotopic ossification was correlated (r = -.25, P = .005) with the aggregate range of hip motion, but had no relationship to the patient's Harris rating. In conclusion, the grading of heterotopic ossification is reliable. Although the severity of heterotopic ossification did not correlate with the Harris scale, the relationship between heterotopic ossification and range of motion indicates that the Brooker index is also a valid measurement.

Hip Joint↗
PubMed2004

[Cubital tunnel syndrome and heterotopic ossification. Eight case reports].

INTRODUCTION: The occurrence of cubital tunnel syndrome during heterotopic ossification is infrequent. Entrapment of the nerve requires early decompression whereas definitive elbow release is often delayed to reduce the risk of recurrence of periarticular ossification. The pathophysiology and treatment of these two conditions are discussed. METHOD: The authors report a retrospective study of eight men (average age 37 years), all with previous head injury. The nerve entrapment was severe in two cases, moderate in four and mild in two. The elbow was ankylosed with a mean flexion deformity of 96 degrees (77 degrees-123 degrees). Management consisted of early decompression and neurolysis with anterior transposition of the ulnar nerve. In four cases elbow release was postponed until maturation of the ossification. RESULTS: The neurolysis results were assessed according to the score of KLEIMAN modified by TEOH. They were excellent in two cases, good in five and bad in one. DISCUSSION: Entrapment of the ulnar nerve in the context of heterotopic ossification seems related to compression and tension on the ulnar nerve. The compression may be due to prolonged pressure of the medial edge of the elbow on the bed of the nerve, or to a periarticular bony bridge and the initial inflammatory reaction of the heterotopic ossification. Ulnar nerve tension seems to be due to prolonged flexion of the elbow joint and to movements of the shoulder and the wrist, on either side of the ankyrozed elbow. Treatment should be by early decompression of the nerve and we recommend, in addition, anterior transposition to reduce the tension on the nerve. The elbow release can be combined with the neurolysis or delayed according to the state of activity of the heterotopic ossification.

Adult↗
PubMed1990

Single-dose radiation therapy for prevention of heterotopic ossification after total hip arthroplasty.

Single-dose radiation therapy was prospectively evaluated for its efficacy in prevention of heterotopic ossification in patients at high risk after total hip arthroplasty. Thirty-one patients (34 hips) were treated between 1981 and 1988. Risk factors for inclusion in the protocol included prior evidence of heterotopic ossification, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Patients with hypertrophic osteoarthritis or traumatic arthritis with osteophytes were not included. Operations on 34 hips included 19 primary total and 11 revision total hip arthroplasties and 4 excisions of heterotopic ossification. All patients received radiotherapy to the hip after operation with a single dose of 700 centigray. Radiotherapy is recommended on the first postoperative day. After this single-dose radiation treatment, no patient had clinically significant heterotopic ossification. Recurrent disease developed in two hips (6%), as seen on radiography (grades 2 and 3). This series documents a 100% clinical success rate and a 94% radiographic success rate in preventing heterotopic ossification in patients at high risk after total hip arthroplasty. Single-dose radiotherapy is as effective as other radiation protocols in preventing heterotopic ossification after total hip arthroplasty. It is less expensive and easier to administer than multidose radiotherapy.

Adult↗
PubMed1997

Short-course indomethacin prevents heterotopic ossification in a high-risk population following total hip arthroplasty.

The efficacy of a 10-day course of indomethacin in preventing heterotopic ossification after total hip arthroplasty was studied in a consecutive series of male patients who were at increased risk for bone formation. Between September 1991 and June 1994, all male patients (123 hips in 109 patients) who underwent total hip, revision, or surface arthroplasty were placed on a 10-day course of indomethacin. Of these, 106 patients (119 hips) successfully completed the 10-day course. There was no significant formation of heterotopic ossification (Brooker grade III or IV). From a group of 45 known heterotopic bone formers following previous total hip arthroplasty, only 2 developed new heterotopic ossification. Overall there were 9 (7.6%) new cases of heterotopic ossification: 7 Brooker grade I (5 primary and 2 revision cases) and 2 Brooker grade II (both primary cases). A 10-day course of indomethacin prevents the more significant grades of heterotopic ossification and is effective at reducing the incidence of heterotopic ossification following total hip arthroplasty. Further, this regimen appears safe and cost effective.

Adult↗
PubMedDate not supplied

[Digital planimetry for exact assessment of peri-articular ossification].

PROBLEM: Currently, non-steroidal anti-inflammatory drugs (NSAID) and radiation have become established as methods of choice in the prevention of ectopic ossifications after total hip replacement. The most effective doses is still not known exact for both. Conventional classification systems only permit a rough distinction of ossifications, so they cannot be used for an exact quantitative measuring. Further, only a limited number of categories can be distinguished. We wanted to find out whether a quantitative measurement of ossifications can be realized, and if small differences in prophylactic effect can be detected in this way. METHOD: By computerized digitized planimetry, we measured ossifications of patients after total hip replacement on plain X-rays of the pelvis. We followed 57 patients for up to 2 years after operation. After marking the ossifications they were measured by drawing the outline with a magnifying glass-mouse. We checked all aspects of precision and reproducibility of the measurements and the comparability with an established classification method (Brooker). RESULTS: The digitized planimetry could be performed on all patients X-rays. It gave a much more differentiated picture compared to the method of Brooker. The method is simple and reproducible, but time consuming. CONCLUSIONS: Digitized planimetry allows a very exact measurement of ectopic bone formation. Compared to conventional classification systems, it differentiates more subtly. In limited, well controlled studies slight differences of prophylactic methods on ossifications can be evaluated. New developments in X-ray technology will make the handling of this method even easier.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2007

[Influence of thyroid cartilage ossification in laryngeal ultrasound].

BACKGROUND: Topological features of the larynx and hypopharynx may be depicted during sonographic examination of the neck, although ultrasound is seen of minor diagnostic importance. The varying extend of thyroid cartilage ossification appears to be the major limiting factor. We intended to assess the sonographic accessability of laryngeal structures with high end resolution ultrasound devices. METHODS AND PATIENTS: We examined 101 patients endoscopically and by ultrasound. Normal laryngeal findings and pathologies were examined and analysed considering limitations by thyroid cartilage ossification. RESULTS: Despite varying grades of ossification, the majority of laryngeal structures were clearly displayed by ultrasound. Ossification was increasing in the elderly. In 16 cases (16 %) ossification prevented a successful evaluation. In 9 cases of malignant tumor and one laryngocele sonographic assessment was able to contribute additional diagnostic information. CONCLUSIONS: Ultrasound of the larynx requires methodical experience of the operator but is capable to depict relevant anatomic structures, even with presence of thyroid cartilage ossification, thus being able to increase diagnostic impact and may save additional imaging modalities.

Adult↗
PubMed2001

Heterotopic ossification in unidentified skeletal remains.

Heterotopic ossification is a benign, ectopic bone growth that develops in muscle and other soft tissue. The exact cause is poorly understood, but it is a rarely serious complication of soft tissue trauma. Its most common form, myositis ossifications traumatica, occurs as a secondary complication of direct muscle injury. However, other forms are less common and can result from specific pathologic conditions, such as spinal cord trauma and metabolic disorders. In patients who have had spinal cord injury and subsequent paraplegia, heterotopic ossification often results in ankylosis of the hip and a loss in range of motion. Ectopic ossification occurs below the injury site, and, although the specific muscle groups can vary, it usually involves those for which the origin and insertion involve the anterior pelvis and proximal femur. In dried bone, heterotopic ossification can appear as a smooth, irregularly shaped benign tumor of mature bone, extending from the surface but not invading the cortical bone. These tumors range in size from a few millimeters to several centimeters. Because heterotopic ossification is often associated with specific types of injuries, it has a unique anthropological use in forensic cases.

Femur↗
PubMed1999

Naproxen in the prevention of heterotopic ossification after total hip replacement.

The effectiveness of naproxen, indomethacin, and a placebo were compared for the prevention of heterotopic ossification after total hip arthroplasty. Eighty-four men at high risk of experiencing heterotopic ossification received randomly either naproxen 750 mg per day, indomethacin 75 mg per day, or a placebo for 6 consecutive weeks after surgery. Efficacy analysis showed that in 70% of patients treated with naproxen, in 34.8% of those treated with indomethacin, and in 15% of those treated with a placebo, no heterotopic ossification appeared on radiographs taken at 6 months. Naproxen was significantly more effective than the placebo or indomethacin in preventing the development of heterotopic ossification. Stratification into five categories, according to Brooker's classification at 6 months, showed that both drugs were equally superior to the placebo. Class III heterotopic ossification occurred only in patients who were given the placebo. The improvement in clinical criteria was comparable in the three groups, although at 6 months there was an improvement in abduction in patients treated with indomethacin compared with those treated with naproxen and the placebo. The overall tolerance was rated good by 87% of patients and 86% of physicians, with no difference between the groups. The results show that naproxen, given daily for 6 weeks, is an effective and safe medication for the prevention of heterotopic ossification after total hip replacement.

Aged↗
PubMed2000

Treatment of ectopic ossification about the elbow.

The surgical treatment of elbow ectopic ossification associated with elbow stiffness has progressed significantly in the past decade. Although previous reports describe inconsistent results and high complication rates, numerous recent reports document not only good results, but also lower complication rates. The current study outlines the authors' treatment of patients with ectopic bone about the elbow. Various modalities have been used for prophylaxis against elbow ectopic ossification in the patient with elbow trauma. However, despite these prophylaxis efforts, periarticular ossification may form and result in disabling elbow stiffness. If ectopic ossification and stiffness develop, operative intervention may be indicated to restore motion. It has been long suggested that operative intervention be delayed for at least 1 year, with earlier intervention thought to predispose to recurrence. Recent reports, however, have documented good results with earlier intervention, from 3 to 6 months after injury. The evaluation of posttraumatic elbow stiffness associated with ectopic ossification is described, followed by a discussion regarding anatomic and functional classifications. Surgery is based on multiple factors including the location of ectopic ossification, the plane(s) of elbow stiffness, and the presence of associated nerve compression. A limited or extended Kocher approach may be used to release most contractures; however, other approaches may be necessary. Surgical technique is described in detail. Meticulous surgical technique is necessary to avoid complications, including triceps avulsion, recurrent elbow stiffness, and hematoma.

Contraindications↗
PubMedDate not supplied

Ossification of the laryngeal cartilages as it relates to computed tomography.

Ossification of adult laryngeal cartilages was studied using cross sections cut in planes parallel to those used in computed tomography (CT). The percentage of ossification of surfaces of thyroid laminae was calculated and marked variations were found. There was no correlation between ossification and age (all subjects were 50 years or older). Generally, laryngeal cartilages of men were ossified to a greater extent than those of women. Some male cartilages were only slightly ossified, however, while some female cartilages were nearly completely ossified. Inner and outer surfaces of thyroid laminae differed by as much as 35% in some cases. Left and right laminae showed even greater differences, indicating that symmetry of ossification is not the rule. Ossification of arytenoid and cricoid cartilages also varies. This study reveals that there is no reliable pattern of ossification of laryngeal cartilage that would be of use the radiologist in evaluating CT scans for invasion of cartilage by cancer.

Aged↗
PubMed1994

Prophylactic indomethacin for the prevention of heterotopic ossification after acetabular fracture surgery in high-risk patients.

Thirty-seven male patients with acetabular fractures requiring an extensile surgical approach were treated using a uniform protocol that was begun in July 1984. In 1987, prophylactic indomethacin was added to the protocol to study its effects on the prevention of heterotopic ossification. Nineteen patients with at least 12 months' follow-up were operated on prior to, and 16 after the initiation of the indomethacin treatment program. Two patients were lost to follow-up. The severity of heterotopic ossification was evaluated for each of these two patient groups using the Brooker classification and was correlated with hip joint mobility. Statistical analysis revealed that indomethacin was effective in decreasing the overall incidence of heterotopic ossification (p < 0.01). The occurrence of severe heterotopic ossification (Brooker class III and class IV) was also significantly reduced (p < 0.01) and functional results thereby improved. The maximal extent of heterotopic ossification was evident by 6 weeks postoperatively in all patients. In the patients receiving indomethacin, heterotopic ossification did not progress after the drug was discontinued.

Acetabulum↗
PubMed2001

Heterotopic ossifications in patients after severe blunt trauma with and without head trauma: incidence and patterns of distribution.

OBJECTIVE: To investigate the incidence and distribution of heterotopic ossifications in patients with blunt multiple trauma with and without associated head trauma. DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS: Patients were included if they were treated between August 1987 and September 1995. Inclusion criteria included age between 16 and 65 years, injury severity score (ISS) of more than twenty points, and clinical reexamination performed more than three years after the initial injury. METHODS: The records of each patient were abstracted to determine the ISS, the Glasgow coma score (GCS), and parameters describing the course of intensive care. For each patient, a reexamination was performed between January and September 1998. Patients with multiple trauma and associated head trauma (Group PTH, polytrauma, GCS less than nine points, and head computed tomography scan abnormalities) and patients with multiple trauma without associated head trauma (Group PT, polytrauma, GCS of at least nine points, and normal head computed tomography scans) were compared. A clinical reexamination was performed to evaluate functional outcome. RESULTS: Sixty-four patients belonged to Group PTH and 124 patients belonged to Group PT. There were no differences in the age (Group PTH, 28.9 +/- 1.6 years; Group PT, 29.2 +/- 2.1 years) or severity of injury (ISS Group PTH, 31.0 +/- 5.3 points; ISS Group PT, 33.0 +/- 6.1 points) among patients in the two groups. The overall incidence of periarticular heterotopic ossification was comparable in patients with multiple trauma with and without head injury (Group PTH, 30 of 64 patients [46.9 percent]; Group PT, 53 of 124 patients [42.7 percent]). The duration of ventilation was significantly higher in Group PT (Group PTH, 9.3 +/- 2.4 days; Group PT, 14.2 +/- 3.1 days; p = 0.02). In the subgroups in which heterotopic ossification developed (PT-HO and PTH-HO), patients in PT-HO had a significantly higher incidence of heterotopic ossification, as compared with patients in PTH-HO at initially uninjured joints (Group PTH-HO, 1 of 30 patients [3.3 percent]; Group PT-HO, 10 of 53 patients [18.9 percent]; p = 0.04). CONCLUSIONS: There was a high incidence of heterotopic ossification around those joints that were initially classified as uninjured in patients without head trauma. This finding suggests that pathogenic pathways independent of head trauma, such as long-term ventilation, play a main role. Causative factors for the development of heterotopic ossification at initially uninjured joints in long-term ventilated patients with multiple trauma with and without head trauma remain to be elucidated.

Adult↗
PubMed1991

Comparative study between magnetic resonance imaging and histopathologic findings in ossification or calcification of ligaments.

Magnetic resonance imaging findings were compared with histopathologic specimens of ossified or calcified ligaments, including the surrounding tissue, to evaluate the usefulness of magnetic resonance imaging as a means to predict the progression of ossification. In addition, factors influencing signal intensity were evaluated by histochemical and immunohistochemical analyses. The area of low signal intensity corresponded to the hyperplastic ligament around the ossification, and to the transitional area between the ligament and the ossification. A mineralization front and chondrocyte proliferation with strong metachromasia were recognized in these areas. The presence of a low-intensity signal area suggested the progression of ossification. The isointensity signal corresponded to proliferation of small vessels in the hyperplastic ligament, presumably representing the initiation of ossification. Histochemically, the metachromasia was intense at the transitional area between the ligament and the ossification, and the main constituent in these areas was chondroitin sulfate. Immunohistochemically, S-100 protein, transforming growth factor-beta 1, and Type II collagen showed an intense immunoreactivity in the chondrocytes, indicating increased production of the extracellular matrix. We postulate that the activation of chondrocytes and the alteration of the extracellular matrix may have affected the signal intensity.

Aged↗
PubMedDate not supplied

Collateral cartilage ossification of the distal phalanx in the Brazilian Jumper horse.

Collateral cartilage ossification of the distal phalanx in the Brazilian Jumper horse is a common finding. The objective of this study was to evaluate the prevalence and the degree of ossification of the collateral cartilages of the distal phalanx in Brazilian Jumper horses. In an analysis of 652 collateral cartilages from the front feet of 163 horses, 93% of these cartilages had collateral cartilage ossification (P < 0.005), and 7% of these cartilages did not have any type of ossification. In ossified cartilages, 86.4% had ossification beginning from the base, and 6.6% had a separate center of ossification.

Age Distribution↗
PubMed1993

Patterns of vertebral ossification and pelvic abnormalities in paralysis: a study of 200 patients.

To clarify the characteristics, extent, and frequency of spinal ossification and abnormalities of the sacroiliac joint, symphysis pubis, and hip in paralysis, routine radiographs of the lumbar spine, pelvis, and abdomen were retrospectively evaluated in 95 quadriplegic, 105 paraplegic, and 100 age-matched control patients, with attention to age and race and to spinal level and duration of paralysis. The spinal radiographs were evaluated for presence of osteophytes, syndesmophytes, paravertebral ossification, and flowing hyperostosis characteristic of diffuse idiopathic skeletal hyperostosis (DISH); the pelvic radiographs were used to measure the widths of the sacroiliac joint, hip, and symphysis pubis articulations and evaluate for presence of enthesopathy. Bone formation around vertebral bodies was often seen in quadriplegic (n = 41 [43%]) and paraplegic (n = 46 [44%]) patients. In quadriplegic patients, four distinct vertebral ossification patterns were evident: osteophytosis, paraspinal ossification resembling that found in psoriasis, syndesmophytosis, and flowing ossification similar to that in DISH. In paraplegic patients, osteophytosis was most frequent. Vertebral ossification in quadriplegic patients was significantly associated with age (P < .01) and increased in frequency and severity with increasing age.

Adult↗
PubMed2004

Effects of ethane-1-hydroxy-1,1-diphosphonate on ossification of the posterior longitudinal ligament in Zucker fatty rats.

PURPOSE: Using Zucker fatty rats as an animal model, we evaluate the effectiveness of ethane-1-hydroxy-1,1-diphosphonate on ossification of the posterior longitudinal ligament by histopathologically investigating the prodromal, early, and advanced stages of ossification of the spinal ligaments. METHODS: 73 Zucker fatty rats were allocated to the ethane-1-hydroxy-1,1-diphosphonate group (n=33) and the control group (n=40). The former group was fed ethane-1-hydroxy-1,1-diphosphonate daily. The feed was given starting 2 months after birth and continued until the rats were killed at 3 to 18 months later. Chemical analysis of the blood, radiographic tests, and histopathological examination were then conducted for both groups. RESULTS: The results showed that ossification of the spinal ligaments involved excessive cartilage cell proliferation around areas affected by enthesitis; enlargement of the fibrocartilage tissue layer; ligament thickening; calcification of the matrix around the cartilage cells; and ossification of the spinal ligaments through enchondral ossification. Radiographic examinations showed that osteoproliferation in vertebral bodies in rats receiving ethane-1-hydroxy-1,1-diphosphonate was generally suppressed compared with controls, whereas histopathological examinations found no clear difference in cartilage cell proliferation in areas affected by enthesitis between the two groups, indicating the absence of calcification or osteo-proliferation in areas affected by enthesitis for the rats receiving ethane-1-hydroxy-1,1-diphosphonate. CONCLUSION: Ethane-1-hydroxy-1,1-diphosphonate is effective in suppressing progressive ligament ossification.

Animals↗
PubMed2003

Heterotopic ossification around the elbow following burns in children: results after excision.

BACKGROUND: Major burn injuries close to joints alter the function of the musculoskeletal system through tissue loss and limitation of joint motion. In children with involvement of the hand, wrist, and forearm, restriction of elbow motion secondary to heterotopic ossification following a burn injury severely limits the function of the upper extremity. The purpose of this study was to review elbow function following excision of heterotopic ossification around the elbow in children. METHODS: Eight children (ten elbows) from a population of 3245 consecutive patients who were admitted to our pediatric burn center were found to have severe heterotopic ossification of the elbow, leading to an inability to reach the mouth for feeding and the head and the perineum for self-care. Excision of the heterotopic ossification was undertaken if the patient had this limitation of function and if movement was restricted to a total arc of motion of <50 degrees. Pain was not an indication for the operation. The procedure was performed at an average of 17.3 months following the injury. RESULTS: Seven children (nine elbows) were available for follow-up at an average of fifty-six months after surgery. All nine elbows had an improved arc of motion (an average increase of 57 degrees ). Following excision, heterotopic ossification did not recur. All children were able to reach the face and the perineum following the operation. CONCLUSIONS: Excision of heterotopic ossification around the elbow following a burn injury in children can improve the arc of motion and improve the function of the extremity. A relatively simple operative and postoperative regimen can achieve satisfactory results.

Adolescent↗