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PubMed2005

Ossification of the Achilles tendon--a case report.

Ossification of the Achilles tendon is a very unusual condition. We report a case with bilateral Achilles tendon ossification followed up for twelve years, treated twice surgically on the left side and conservatively on the right side. At the age of 51, the patient's plain radiogram showed bilateral ossifications of the Achilles tendon (right 55 mm, left 15 mm in length). The left side small mass was removed. The right side mass was decided to be followed up because of its large size. At the age of 61, ossification recurred on the left side. Conservative treatment with etidronate disodium for two years failed to prevent ossification from progressing. At the age of 63, the mass on the right and left sides increased to 70 mm and 45 mm in length, respectively. The mass of the left side was excised again, and dull pain disappeared postoperatively on the left side.

Achilles Tendon↗
PubMedDate not supplied

Syndesmosis sprains of the ankle. The influence of heterotopic ossification.

A retrospective study of 50 syndesmosis sprains in 44 football players was performed. Five patients (6 ankles) were lost to follow-up, allowing review of 44 injuries. Average follow-up was 47 months. The patients were evaluated for recurrent injury, overall ankle function, and for persistent ankle symptoms, including stiffness, pain, limping, and swelling. Follow-up radiographs of the injured ankle were obtained in 22 patients. The average return time to full activity was 31 days. Pain with pushing-off was a major factor preventing return to activity. At final followup, 36% of the patients complained of persistent mild to moderate stiffness of the ankle. Twenty-three percent had mild to moderate pain, usually with activity. One patient had a mild limp with activity, and 18% of the ankles had persistent mild to moderate swelling. Ankle function was rated as good to excellent in 86%. All patients with fair results had recurrent ankle sprains. There were no poor results. Eleven of the 22 patients with follow-up radiographs developed heterotopic ossification within the interosseous membrane, but no patient developed a frank synostosis. The patients with heterotopic ossification required an average of 11 days more recovery time than those without ossification. There was no significant difference between the 2 groups' ultimate ratings of ankle function or ankle symptoms, but the ankles with heterotopic ossification were associated with more recurrent lateral ankle sprains. We conclude that syndesmosis sprains require a longer recovery period than other types of ankle sprains. Most of these injuries showed good to excellent ankle function after recovery, unless there was a recurrent ankle sprain.2+ formation of heterotopic ossification.

Adult↗
PubMed2006

Indometacin as prophylaxis for heterotopic ossification after the operative treatment of fractures of the acetabulum.

Our study was designed to compare the effect of indometacin with that of a placebo in reducing the incidence of heterotopic ossification in a prospective, randomised trial. A total of 121 patients with displaced fractures of the acetabulum treated by operation through a Kocher-Langenbeck approach was randomised to receive either indometacin (75 mg) sustained release, or a placebo once daily for six weeks. The extent of heterotopic ossification was evaluated on plain radiographs three months after operation. Significant ossification of Brooker grade III to IV occurred in nine of 59 patients (15.2%) in the indometacin group and 12 of 62 (19.4%) receiving the placebo. We were unable to demonstrate a statistically significant reduction in the incidence of severe heterotopic ossification with the use of indometacin when compared with a placebo (p = 0.722). Based on these results we cannot recommend the routine use of indometacin for prophylaxis against heterotopic ossification after isolated fractures of the acetabulum.

Acetabulum↗
PubMed2002

Nucleotide pyrophosphatase gene polymorphism associated with ossification of the posterior longitudinal ligament of the spine.

Ossification of the posterior longitudinal ligament (OPLL) of the spine is a disease that causes paralysis by compressing the spinal cord. Based on the fact that the nucleotide pyrophosphatase (Npps) gene is responsible for ectopic ossification in ttw, an OPLL model mouse, the possibility was explored whether the human NPPS gene is associated with susceptibility to and severity of OPLL. First, we screened for single-nucleotide polymorphisms (SNPs) in the human NPPS locus using selected 25 OPLL patients with young onset (< 35 years old) or severe ossification (> 10 ossified vertebrae), and identified three novel SNPs in the locus. A case-control association study between 180 OPLL patients and 265 non-OPLL controls showed that one of these SNPs, IVS15-14T --> C substitution, was more frequently observed in OPLL patients (p = 0.022), especially in those with severe ossification (p < 0.0001) and young onset (p = 0.002), than in controls. A stratified study with the number of ossified vertebrae in OPLL patients revealed that IVS15-14T --> C substitution (p = 0.013) as well as young onset (p = 0.046) and female sex (p = 0.006) were associated with severe ossification. We conclude that the IVS15-14T --> C substitution in the human NPPS gene is associated not only with susceptibility to, but also with severity of OPLL.

Adult↗
PubMed1993

The natural history of heterotopic ossification in patients who have fibrodysplasia ossificans progressiva. A study of forty-four patients.

Forty-four patients who had fibrodysplasia ossificans progressiva responded by mail to a questionnaire regarding the age at the onset of heterotopic ossification at fifteen commonly involved anatomical sites. The average age of the patients when they responded to the questionnaire was twenty-seven years (range, three to sixty-nine years). The average age at the onset of ossification was five years (range, birth to twenty-five years). The most common sites of early heterotopic ossification were the neck, spine, and shoulder girdle. Thirty-five (80 per cent) of the patients had had some restrictive heterotopic ossification by the age of seven years. By the age of fifteen years, forty-two (more than 95 per cent) of the patients had severely restricted mobility of the upper limbs. In these patients, heterotopic ossification proceeded in a direction that was axial to appendicular, cranial to caudad, and proximal to distal; this pattern appeared typical for fibrodysplasia ossificans progressiva.

Adolescent↗
PubMed1999

Excision for the treatment of periarticular ossification of the knee in patients who have a traumatic brain injury.

BACKGROUND: Patients who are comatose after a traumatic brain injury often have heterotopic periarticular ossification that can be treated with excision to improve the range of motion of the joint. METHODS: Areas of periarticular ossification were resected at an average of twenty-three months after recovery from a coma in seven knees of five patients who had a traumatic brain injury. Before the procedure, all of the knees were fixed in a flexed position that ranged from 10 to 40 degrees and they had a painful arc of motion that ranged from 20 to 70 degrees of flexion. None of the patients could walk, and some of them could barely sit in a wheelchair. At the end of the operation, the arc of motion was markedly improved in all of the knees (0 to 130 degrees in three knees, 0 to 120 degrees in three, and 10 to 120 degrees in one). In an attempt to prevent postoperative loss of motion and recurrence of the ossification, continuous passive motion was applied to the involved knee for six weeks before a full rehabilitation program was started. The latest follow-up evaluation was at an average of thirty-four months (range, twenty-five to sixty months). RESULTS: At the time of follow-up, all of the patients could walk and all of the knees were pain-free. One knee had an arc of flexion of 0 to 90 degrees; two, an arc of 10 to 100 degrees; one, an arc of 5 to 110 degrees; two, an arc of 0 to 120 degrees; and one, an arc of 0 to 130 degrees. Ossification did not recur in any of the knees. CONCLUSIONS: Patients with good neuromuscular control had the best general functional result. The routine use of a continuous-passive-motion machine was associated with no recurrence of ossification, and there was some late loss of motion after its use was discontinued.

Adolescent↗
PubMed1975

Clinical survey of and pathogenic approach to para-articular ossifications in long-term coma.

1. Thirteen patients with para-articular ossification complicating long-term coma are presented. In a series of 26 patients with long-term coma following cerebral traumatic lesions, seven cases were found with para-articular ossification. 2. The high frequency of elbow involvement is emphasized, and in all these cases posterior ossifications were present. 3. In five patients, ossifications were observed in limbs which were not paralytic and in which integrity of the efferent nerve tracts could be demonstrated. 4. The importance of functional or paralytical immobility and of a completely bedridden condition in the patients is emphasized. 5. The aetiopathogenesis of para-articular ossifications still remains unknown, but a prolonged complete immobilization possibly induces vasomotor, metabolic and trophic disorders, which can give rise to metaplasia.

Adolescent↗
PubMed1975

Para-articular ossifications after primary prosthetic replacement ad modum Austin T. Moore.

This study concerns the frequency of para-articular ossifications after primary prosthetic replacement ad modum Austin T. Moore in the treatment of unstable fractures of the femoral neck. In 121 patients who were X-rayed after surgery ossifications were found in 45 per cent of the cases. Patients that preoperatively had severe coxarthritis or rheumatoid arthritis are excluded. Two thirds of the bone formations described were very small and without clinical importance. About 20 per cent of the ossifications were of a considerable size, but no clinical consequences could be demonstrated. About 12 per cent of the ossifications--6 per cent of all the patients in this study--were large, and only in this group could a compromised hip function be found. It seems as the process of ossification is limited to the first 3 postoperative months. There is a good correlation between the communications regarding ectopic bone formation after total hip replacement and the frequency found in this study.

Aged↗
PubMed2003

Synovial sarcoma with massive ossification--a case report.

Synovial sarcoma with extensive osteoid production is rare. We report a case of synovial sarcoma of monophasic type with massive ossification. The diagnosis was confirmed by reverse-transcripitase polymerase chain reaction (RT-PCR). The patient was an-81-year-old woman with recurrent synovial sarcoma in her right knee. The tumor was primarily excised in 1989. It recurred and was removed again in 1996. However, in 1999 a painful mass appeared in the same site. Preoperative plain radiography and computed tomography revealed a 5 x 5 cm soft tissue mass with extensive ossification in the medial side of the right knee joint. The tumor was widely excised in 2000. Soft X-ray examination revealed a trabecular pattern of ossification in the excised tumor. Microscopically the tumor was composed of hypercellular spindle cells with fascicular arrangement with prominent ossification but no epithelial component. The tumor cells were positive for vimentin and focally positive for cytokeratin. The tumor expressed a sequence of SYT-SSX1 fusion gene transcript demonstrated by RT-PCR. Twelve years long survival of the present case without metastasis in spite of repeated recurrence suggests a better prognosis of synovial sarcomas with ossification.

Aged↗
PubMed2006

Repetitive tensile stress to rat caudal vertebrae inducing cartilage formation in the spinal ligaments: a possible role of mechanical stress in the development of ossification of the spinal ligaments.

OBJECT: Mechanical stress has been considered one of the important factors in ossification of the spinal ligaments. According to previous clinical and in vitro studies, the accumulation of tensile stress to these ligaments may be responsible for ligament ossification. To elucidate the relationship between such mechanical stress and the development of ossification of the spinal ligaments, the authors established an animal experimental model in which the in vivo response of the spinal ligaments to direct repetitive tensile loading could be observed. METHODS: The caudal vertebrae of adult Wistar rats were studied. After creating a novel stimulating apparatus, cyclic tensile force was loaded to rat caudal spinal ligaments at 10 N in 600 to 1800 cycles per day for up to 2 weeks. The morphological responses were then evaluated histologically and immunohistochemically. After the loadings, ectopic cartilaginous formations surrounded by proliferating round cells were observed near the insertion of the spinal ligaments. Several areas of the cartilaginous tissue were accompanied by woven bone. Bone morphogenetic protein-2 expression was clearly observed in the cytoplasm of the proliferating round cells. The histological features of the rat spinal ligaments induced by the tensile loadings resembled those of spinal ligament ossification observed in humans. CONCLUSIONS: The findings obtained in the present study strongly suggest that repetitive tensile stress to the spinal ligaments is one of the important causes of ligament ossification in the spine.

Animals↗
PubMed2002

Elbow heterotopic ossification in head-trauma patients: diagnosis and treatment.

Heterotopic ossification is a disorder characterized histologically and radiographically by normal bone formation in soft tissues that normally have no ossification properties. In severe head-trauma patients, a high incidence of heterotopic ossification occurs. The diagnosis of this pathology in these patients often is difficult for residual neurological damage. The etiology of heterotopic ossification following head trauma is unknown. Similarities have been found between heterotopic ossification and myositis ossificans, a hereditary autosomal dominant disease.

Adolescent↗
PubMed1979

Ossification of the posterior longitudianl ligament of the cervical spine: subtotal vertebrectomy as a treatment.

If the ossification is localized in the central part of the intervertebral space, anterior decompression surgery of Cloward may be indicated. However, if most posterior ligamentous ossification covers the posterior surface of the vertebral body and the lateral sides, Cloward's method is not indicated. We have developed a method of anterior decompression and fusion surgery to clear the ossified area, resecting the vertebral body (subtotal vertebrectomy). The results were excellent in 3 of 4 patients with preoperative radiculopathy; there were 2 excellent and 16 good results in 22 patients with myelopathy. Of course laminectomy can produce some good effects, but the anterior obstruction removes through the anterior approach. Anterior decompression may be indicated when ossification is localized below the C3--4 intervertebral space, and when the spinal canal is not narrowed in the upper cervical region, even if ossification extends over the whole cervical spine. Laminectomy is advised when ossification involves all levels of the cervical spine, the upper cervical spine is narrowed or the sagittal dimension of the spinal canal is reduced more than 60%.

Cervical Vertebrae↗
PubMed2003

Familial clustering of dendriform pulmonary ossification.

Dendriform pulmonary ossification is an extremely rare disease, which is usually found and analysed postmortem. Pathogenesis of pulmonary ossification is therefore still unknown. We describe two males in the same family (a 29 year-old patients and his 58 year-old father) with pulmonary ossification. The young male was symptomatic pneumothorax but his father had been asymptomatic since youth. Familial clustering of pulmonary ossifications strongly suggests a genetic predisposition for the pathogenesis. This is the first report of two cases of dendriform pulmonary ossification in the same family.

Adult↗
PubMed1992

Prophylaxis with indomethacin for heterotopic ossification after Chiari osteotomy of the pelvis.

One hundred patients who had painful dysplasia of the hip were treated with a Chiari osteotomy of the pelvis, and the postoperative radiographs were reviewed for the development of heterotopic ossification. Sixty patients did not receive indomethacin postoperatively, and eighteen (30 per cent) had heterotopic ossification of at least class 1; forty patients received indomethacin for two weeks postoperatively, and only three (8 per cent) of them had heterotopic ossification. This difference was significant (p < 0.025). No class-3 or 4 heterotopic ossification was seen in the patients who were given indomethacin. The prevalence of side-effects was relatively low, and no delayed union of the osteotomy was observed in any patient. We concluded that indomethacin, in the dosage schedule and regimen that we used, provides effective prophylaxis for heterotopic ossification after a Chiari pelvic osteotomy.

Female↗
PubMed1992

Heterotopic ossification in children with burns: two case reports.

Heterotopic ossification is the formation of ectopic bone in soft tissue, and has been reported as a rare complication in pediatric burn patients. At our hospital, two 86% body surface area burn patients developed heterotopic ossification in the shoulder, elbows, distal femur, proximal tibia, fibula, and ribs approximately four months after the burn injury. These two rare and unusual cases are presented documenting the clinical involvement, radiological studies, laboratory data, as well as treatment of their heterotopic ossification. Discussion will focus on the incidence, diagnosis, pathophysiology, and treatment of heterotopic ossification in burn patients and how this information relates to the specific diagnosis and management of the complication of heterotopic ossification in the burn child.

Burns↗
PubMedDate not supplied

Aspiration cytology of heterotopic ossification. A case report.

Heterotopic ossification (myositis ossificans) is usually a posttraumatic reactive process involving new bone formation. This nonneoplastic process can be clinically and radiologically confused with osteosarcoma. A case of heterotopic ossification is reported in which cytologic material was obtained from a partially calcified thigh mass from a 17-year-old, athletic male. Aspiration cytology revealed numerous osteoclastic giant cells containing multiple plump nuclei. These cells were admixed in a benign-appearing stromal background composed of mature fibroblasts and were typified by elongated spindle cells. A small incisional biopsy showed new bone formation, osteoclasts, osteoblasts and fibroblasts consistent with maturing heterotopic ossification. Heterotopic ossification may be distinguished cytologically from osteosarcoma by the presence of numerous uniform benign stromal cells composed of mature fibroblasts and osteoclastic giant cells. The differential diagnosis may be more difficult in the early stages of this reactive and proliferative process. Adequate sampling of suspected heterotopic ossification by aspiration cytology may avoid surgery in a selected group of patients.

Adolescent↗
PubMed2005

[Surgical removal of debilitating neurogenic heterotopic ossifications of the hip].

Two men, aged 24 and 52 years, developed neurogenic heterotopic ossifications of the hip, the first following a cervical spinal-cord injury and the second after prolonged artificial ventilation following bowel surgery. The stiffness caused problems when sitting and when performing general daily activities; the second patient who was ambulatory, also had problems walking. CT investigation clearly showed the localisation of the ossifications. After surgical removal of the ossifications both patients were able to sit for longer periods without low-back pain and the ambulatory function of the second patient was much improved. Indomethacin was given postoperatively and no recurrence of the ossification was seen. A number of per- and postoperative complications are associated with the surgical removal of neurogenic heterotopic ossifications of the hip. These include damage to surrounding structures and infection. However taking into account the improved range of movement and increased independence of the patient, it is a useful intervention for this debilitating condition.

Adult↗
PubMed2006

[The risk factors and preventive strategies of heterotopic ossification after artificial disc replacement in lumbar spine].

OBJECTIVE: To analyze the risk factors of heterotopic (HO) ossification after total lumbar disc replacement and probe the preventive strategies for it. METHODS: The radiographs and clinical data of 78 discs in 65 patients who received artificial lumbar disc replacement (ADR) from April 1998 to December 2003 were analyzed retrospectively by two radiologists and one orthopaedic surgeon and then postoperative HO were graded according to McAfee system. The bony formations in disc spaces, time of HO were found, and range of motion (ROM) of the operated levels were measured on radiographic films. In addition, the risk factors such as preoperative peri-annulus ossification, bony endplates injuries, and subsided or mal-position of the prostheses were also analyzed by Logistic regression analysis. RESULTS: Postoperative HO was found in 10 spaces of 9 cases. Class I of HO were occurred in 7 patients at means 2.1 years postoperatively with normal range of motion preserved. Three of them turned into class II or III with 10 degrees of mean ROM in the following 2.5 years. Another 2 (2/9) cases with preoperative peri-annulus ossification had bridging trabecular bone (class III) between the endplates and 9 degrees of ROM 2 years after surgery, then turned into class IV at 6 years with 0 degrees and 4 degrees of motion in the operated levels. As the risk factors of HO, preoperative annulus ossification (2 cases), bony endplates injuries (5 cases), mal-positioned prostheses (2 cases) and subsided prostheses (2 cases) were found simultaneity with significant positive relation to HO occurred (P < 0.05). CONCLUSIONS: Factors such as preoperative ossification of annulus, endplate injuries, prosthesis subsided and mal-position would have higher risks to have HO occurred after ADR, but ROM of most affected levels are preserved. Strict control indication and avoid all above risk factors can prevent HO occurring effectively.

Adult↗