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PubMedDate not supplied

[Ossification of the distal femoral epiphysis. On the question of osteochondrosis dissecans in children].

The authors report on ossification variants: roughness (Ludloff: protruberances), so-called isolated ossification centers or islands and accessory ossification centers which are illustrated with reference to personal observations. Their clinical significance is pointed out. The existence of osteochondrosis dissecans in children and pre-adolescents is refuted, especially since no histologically proven observation has been described in the literature.

Adolescent↗

PubMed1989

[Intraocular ossification].

Following a general introduction to the problem of heterotopic bone formation the pathogenetic stages of intraocular ossification are described. Intraocular ossification was found in 30 (7%) of 423 eyes enucleated between 1974 and 1984. In 60% of the eyes the ossification was associated with trauma, in 25% with chronic uveitis. Bone formation started between four and 44 years after the onset of ocular disease and in most cases originated in the retinal pigment epithelium.

Adolescent↗

PubMed2003

Auricular ossificans (ectopic ossification of the auricle).

The petrified auricle is an unusual clinical entity in which the ear becomes partially or totally rigid, which may result from local trauma, inflammation, or systemic diseases. This process is most commonly secondary to ectopic calcification, but rarely ossification is responsible. Severe hypothermia (frostbite) is the most common cause of auricular ossificans. Only 9 cases of histologically proven ossification of the ear have been reported in the English-language literature. Because of its rarity, there is a paucity of articles addressing its treatment. We report a case of unilateral auricular ossificans believed to be secondary to cold injury. Ectopic ossification was detected on both radiologic and histologic examination. The previously reported cases are reviewed and possible causative factors are discussed.

Aged↗

PubMed2004

Critical roles for collagenase-3 (Mmp13) in development of growth plate cartilage and in endochondral ossification.

Collagenase-3 (MMP13), a member of the matrix metalloproteinase (MMP) family of neutral endopeptidases, is expressed in the skeleton during embryonic development and is highly overexpressed in human carcinomas and in chondrocytes and synovial cells in rheumatoid arthritis and osteoarthritis. To determine the functional roles of Mmp13, we generated Mmp13-null mice that showed profound defects in growth plate cartilage with markedly increased hypertrophic domains as well as delay in endochondral ossification and formation and vascularization of primary ossification centers. Absence of Mmp13 resulted in significant interstitial collagen accumulation due, in part, to the lack of appropriate collagenase-mediated cleavage that normally occurs in growth plates and primary ossification centers. Cartilaginous growth plate abnormalities persisted in adult mice and phenocopied defects observed in human hereditary chondrodysplasias. Our findings demonstrate a unique role of Mmp13 in skeletal development.

Animals↗

PubMed2006

Diffuse pulmonary ossification: an uncommon incidental autopsy finding.

AIM: To determine the incidence of diffuse pulmonary ossification (DPO) and its subtypes at autopsy and correlation with clinical and histological features. METHODS: Autopsy reports from our institution over a 64-month period were reviewed for findings of DPO. The pattern of ossification, demographics and clinical data were obtained from both paraffin sections and final autopsy reports. In a selected case, chest radiograph and wet tissue were obtained. RESULTS: Seventeen histologically confirmed cases of DPO were found in 10,426 autopsy cases, representing an incidence of 1.63 cases/1000 autopsies. There was a predilection in males (88%) and underlying pulmonary disease (88%). In contrast to published studies, dendriform DPO was more common than the nodular type in our cohort (11 and 6 cases, respectively). The dendriform type was more commonly associated with marrow elements. CONCLUSIONS: Diffuse pulmonary ossification is uncommon and rarely diagnosed during life, but can easily be identified when sectioning the lungs at autopsy. There is recent renewed interest in diagnosing and determining the significance of DPO using high resolution computed tomography and thoracoscopic biopsy.

Adult↗

PubMed2006

Scleral ossification in phthisical eyes.

Heterotopic secondary ossification of the eye usually affects intraocular tissues. Although calcium deposition in the scleral lamellae is not uncommonly observed, bone formation is only rarely associated with chromosomal abnormalities or colobomatous eyes. Herein two cases of both scleral and intraocular ossification in patients with long-standing ocular phthisis are reported. The cases of idiopathic scleral ossification, albeit exceedingly rare, suggest that osteogenic precursor cells may reside in the sclera, as well and though very rarely, these cells can also be stimulated to form heterotopic bone by a traumatic or inflammatory local event.

Adult↗

PubMed1995

Spinal cord compression caused by ossification of the transverse ligament of the atlas.

Although ossification of the posterior longitudinal ligament and ligamentum flavum are well known, ossification of the transverse ligament of the atlas is extremely rare. We present the case of a 79-year-old man who developed a gradually progressive spastic quadriparesis caused by upper cervical canal stenosis due to ossification of the transverse ligament of the atlas together with ligamentum flavum hypertrophy.

Aged↗

PubMed1997

Treatment of heterotopic ossification after spinal cord injury.

A new protocol in management of heterotopic ossification (HO) was evaluated in 46 patients after spinal cord injury (SCI). A group of 24 paraplegic and 22 tetraplegic patients was involved in a prospective study. Diagnosis of HO was made by bone scintigraphy and radiographic evaluation. Patients were divided into two groups. Group I was made up of 33 patients with positive bone scintigraphy and negative evidence of HO and Group II was made up of 13 patients with positive bone scintigraphy and positive radiographic evidence of HO. Etidronate was started intravenously (300 mg/day) for three days followed by oral therapy for six months (20 mg/kg/day). Follow-up of patients was 15.7 +/- 8 months after SCI. In Group I, etidronate therapy prevented the development of HO in 79 percent of patients; in 21 percent of patients, a low degree of tissue ossification was found which was not clinically significant. In Group II, there was an inhibitory effect of etidronate on progression of soft tissue ossification in six patients. The remaining seven patients did not respond to therapy and showed an increased growth of HO. Our data indicate that etidronate may prevent HO in the majority of patients when administered at an early stage of HO development and in higher doses than are routinely recommended.

Administration, Oral↗

PubMed2005

Heterotopic ossification: a review.

Heterotopic ossification is defined as the presence of lamellar bone at locations where bone normally does not exist. The condition must be distinguished from metastatic calcifications, which mainly occur in hypercalcaemia, and dystrophic calcifications in tumours. It is a frequent complication following central nervous system disorders (brain injuries, tumours, encephalitis, spinal cord lesions), multiple injuries, hip surgery and burns. In addition to this acquired form, hereditary causes also exist, such as fibrodysplasia ossificans progressiva, progressive osseous heteroplasia and Albright's hereditary osteodystrophy. Although these conditions are extremely rare, they can provide useful information on the physiopathology of heterotopic ossification, and thus lead to novel and causal treatment modalities. Heterotopic ossification is no trivial complication. A limitation of the range of joint motion may have serious consequences for the daily functioning of people who are already severely incapacitated because of their original lesion. Increased contractures and spasticity, pressure ulcers and increasing pain further compromise the patient's capabilities. Consequently, we feel that attention should be paid to the pathogenesis and particularly the prevention and treatment of this disorder.

Burns↗

PubMed1981

Increased prevalence of HLA-B27 in patients with ectopic ossification following traumatic spinal cord injury.

The histocompatibility antigen HLA-B27 was determined in 43 patients with post-traumatic spinal cord injury (SCI). The prevalence of B27 was significantly increased in the SCI patients with ectopic ossification. Five of 21 patients with ectopic bone had B27 compared to none of the 22 patients without ossification (P = 0.021). This finding indicates that HLA-B27 is a genetically determined risk factor for the development of heterotopic ossification following injury to the central nervous system. Future studies may determine that HLA-typing can identify a group of patients at a high risk of a disabling complication of SCI who should be treated prophylactically to prevent ectopic bone.

Adult↗

PubMedDate not supplied

Heterotopic ossification in moyamoya disease: a case report.

Moyamoya disease is a rare disorder of cerebrovascular circulation. A review of the literature failed to reveal the association of heterotopic ossification in patients with this disease; such a case is now presented. The patient described had atraumatic intracranial hemorrhage, was in a coma for a period of time, underwent ventriculostomy and shunt placement, and was left with residual spastic hemiparesis. Evidence of heterotopic ossification around the hemiparetic shoulder and hip was subsequently noted on radiographic studies and was managed conservatively. Heterotopic ossification may be a rare complication of the neurological deficits associated with moyamoya disease and needs careful consideration when joint stiffness persists, despite usual conservative measures.

Cerebral Angiography↗

PubMed2002

Symptomatic os subfibulare caused by accessory ossification: a case report.

Separated ossicles at the tip of the lateral malleolus, the condition known as os subfibulare, are sometimes a cause of ankle pain. There are two theories regarding the origin of os subfibulare. One theory proposes that it is caused by an avulsion fracture attributable to pull of the anterior talofibular ligament, whereas the other theory proposes that it is the result of an accessory ossification center. However, some authors have reported that os subfibulare is an avulsion fracture and few reports of accessory ossification have been described recently. A patient with os subfibulare that may have been caused by accessory ossification rather than an avulsion fracture was treated by the current authors.

Adolescent↗

PubMed2005

Excision of heterotopic ossification from the knee: a functional outcome study.

UNLABELLED: We retrospectively reviewed 17 consecutive patients with neurologic injuries (22 knees) who had excision of heterotopic ossification (22 knees, five bilateral) of the knees. Our primary research goal was to determine the change in range of motion at the knee after resection of heterotopic ossification in patients with neurologic injuries. Our secondary research goal was to determine the mobility gains measured regarding ambulatory and sitting functions for these patients. Diagnoses included traumatic brain injury (15 patients), anoxia (one patient), and spinal cord injury (one patient). The average age of the patients was 33 years (range, 19-51 years). Data were collected by an independent observer and included range of motion of the knee, ambulatory ability according to a five-level scale, and sitting ability according to a three-level scale. The average followup was 32 months. Range of motion improved by 65 degrees postoperatively. Extension improved from a preoperative mean of 16 degrees to a postoperative mean of 2 degrees . Flexion improved from a preoperative mean of 57 degrees to a postoperative mean of 107 degrees . Ambulatory and sitting function improved as a result of treatment. Surgical excision of heterotopic ossification of the knee is an effective procedure to increase joint mobility and function. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series-no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adult↗

PubMedDate not supplied

Heterotopic ossification: are range of motion exercises contraindicated?

The incidence, time of onset, and role of exercise in the progression of heterotopic ossification were documented retrospectively in burn patients. In 12 of 1,066 patients (1.2%) consecutively admitted to a burn center, the abnormal bone formed posteriorly around the elbow joint. The initial signs were localized joint pain and rapid decrease in range of motion, and the average time of onset was 12 weeks after thermal injury. Prior to the diagnosis of heterotopic ossification, all patients were managed with an exercise program of active and active-assisted movements. In patients who persisted with passive and active-assisted range of motion, especially beyond the range of pain-free movements, the ossification progressed to complete ankylosis and required surgical intervention to remove the heterotopic bone. On the other hand, postoperative patients and patients who followed a program of active exercise within the pain-free range gained excellent range of motion. It was concluded that passive stretching of the periarticular structures during the acute phase of heterotopic bone formation is detrimental to the final outcome.

Adult↗

PubMedDate not supplied

Vocal cords dysfunction resulting from heterotopic ossification in a patient with burns.

Limitation of movement of vocal cords developed in a 38-year-old man after he received a 45% second- and third-degree burn with ossification about the cricoarytenoid joints, which indicated that the lesion had been caused by heterotropic ossification. To the best of our knowledge, this is the first report in medical literature of heterotopic ossification as a mechanical cause of vocal cords dysfunction in the patient with critical burns. Diphosphonate (Didronel) treatment has improved the function of the vocal cords after 11 months of therapy.

Adult↗

PubMed1990

Heterotopic ossification.

Heterotopic ossification is becoming increasingly recognized as a phenomenon that can complicate trauma to the head and spinal cord. It can be a disabling accompaniment of thermal injury, and it may seriously compromise results in hip arthroplasty and the treatment of acetabular fractures. Etiologic factors, which are imprecise and incompletely understood, vary with the clinical situation. The five cases reported here illustrate the radiologic appearances, complications, and diagnostic problems, including the difficulty in determining the timing of surgical resection. Reported for the first time are cases of neurogenic heterotopic ossification associated with bilateral shoulder involvement and bilateral ulnar nerve entrapment at the elbow. Heterotopic ossification may mimic acute arthritis.

Adult↗

PubMed1991

Thoracic myelopathy caused by ossification of the ligamentum flavum. Clinicopathologic study and surgical treatment.

The authors reviewed 14 patients with thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). The predominant locality of symptomatic OLF was at the thoracolumbar junction, particularly at T10-11 followed by T11-12. At the level of the thickest OLF in each patient, there were three types of OLF from computed tomography and operative findings: a lateral type in 3 patients, diffuse in 8, and thickened nodular in 3. The diagnosis of OLF-related thoracic spinal canal stenosis was best made by enhanced computed tomography. Histologic study revealed that the developmental mode of OLF was mainly endochondral ossification. Numerous fibrocartilaginous cells were found in the increased and swollen collagen fibers forming the hypertrophic ligamentum flavum (HLF). Ossification extended along the superficial layer of HLF. The size or extension of OLF was relevant to the corresponding diathesis of spinalhyperostosis. Results of laminectomy for OLF were poor because of the high occurrence of complications early on or later deterioration. Therefore, laminoplasty is recommended as a successful procedure for OLF-related thoracic myelopathy, avoiding further local mechanical stress due to tensile force.

Female↗

PubMed1994

The significance of the cervical soft disc herniation in the ossification of the posterior longitudinal ligament.

The significance and role of cervical soft disc hernia in ossification of the posterior longitudinal ligament were investigated based on 54 surgical cases. The types of ossification of the posterior longitudinal ligament were divided into three sub-types: segmental, continuous, and mixed types. In the current series, there were 29 segmental type, 12 continuous type, and 13 mixed type. In the 29 segmental type, 23 patients had accompanying cervical disc hernias (79%). In the 12 continuous type, only 2 patients (17%), and in the 13 mixed type, 5 patients (33%), had accompanying disc hernias. According to the current study, an essential difference exists between the segmental type and the continuous or mixed types. In addition, the current result seems to indicate that, at least in the segmental type, disc herniation is not the promoting or initiating factor of ossification of the posterior longitudinal ligament, but that, in these cases, the fragility of the posterior longitudinal ligament may increase the chance of a disc hernia.

Adult↗