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PubMed2004

Heterotopic ossification of the elbow in patients with burns. Results after early excision.

Heterotopic ossification which may develop around the elbow in patients with burns may lead to severe functional impairment. We describe the outcome of early excision of such heterotopic ossification in 28 patients (35 elbows), undertaken as soon as the patient's general and local condition allowed. The mean age at operation was 42 years. The mean area of burnt body surface was 49%. The mean pre-operative range of movement was 22 degrees in flexion/extension and 94 degrees in pronation/supination. The mean time between the burn and operation was 12 months with the median being 9.5. The mean follow-up period was for 21 months. At the last review, the mean range of movement was 123 degrees in flexion/extension and 160 degrees in pronation/supination. Clinical evidence of recurrence was seen in four patients, occurring within the first two months after operation. Nevertheless, three of these elbows gained 60 degrees or more in flexion/extension and in pronation/supination. Based on this experience, we recommend early surgical treatment of heterotopic ossification of the elbow in patients with severe burns.

Adolescent↗
PubMed2005

Symptomatic ossification of the anterior longitudinal ligament with stenosis of the cervical spine: a report of seven cases.

Seven men with a mean age of 63.9 years (59 to 67) developed dysphagia because of oesophageal compression with ossification of the anterior longitudinal ligament (OALL) and radiculomyelopathy due to associated stenosis of the cervical spine. The diagnosis of OALL was made by plain lateral radiography and classified into three types; segmental, continuous and mixed. Five patients had associated OALL in the thoracic and lumbar spine without ossification of the ligamentum flavum. All underwent removal of the OALL and six had simultaneous decompression by removal of ossification of the posterior longitudinal ligament or a bony spur. All had improvement of their dysphagia. Because symptomatic OALL may be associated with spinal stenosis, precise neurological examination is critical. A simultaneous microsurgical operation for patients with OALL and spinal stenosis gives good results without serious complications.

Aged↗
PubMed2000

Heterotopic ossification of degenerating rat skeletal muscle induced by adenovirus-mediated transfer of bone morphogenetic protein-2 gene.

In vivo gene transfer is a recently developed device for efficient delivery of a therapeutic recombinant protein. We formulated the hypothesis that a high level of expression of bone morphogenetic protein 2 (BMP-2) could be a future therapeutic modality in terms of inducing substantial bone formation in vivo. First, to test this hypothesis, adenoviruses carrying BMP-2 gene were directly injected into the soleus muscle of adult rat. The BMP-2 gene was successfully overexpressed in the target muscle by adenovirus-mediated transfer, whereas bone formation in and around the muscle failed to occur in this case. Second, to recruit putative osteoprogenitor cells, we then induced ischemic degeneration of the target muscle by orthotopically grafting it simultaneously with the gene transfer. The combination of BMP-2 gene transfer and orthotopic muscle grafting resulted in successful ossification of almost the whole grafted muscle, whereas neither muscle grafting alone nor the combination of muscle grafting and adenovirus-mediated transfer of reporter gene LacZ induced any bone formation in the muscle. The ossification process was evident by positive von Kossa staining of the histological sections and roentgenographical radio-opacity of the region. It was also found that the BMP-2 transgene overexpressed in grafted muscles inhibited muscle regeneration, which should otherwise follow the muscle degeneration. We further demonstrated an up-regulation of BMP receptor type IA in grafted muscles, suggesting its involvement in the bone-formation process. In conclusion, overexpression of BMP-2 gene induced massive heterotopic ossification in skeletal muscles under graft-induced ischemic degeneration, which possibly up-regulates osteoprogenitor cells in situ.

Adenoviridae↗
PubMedDate not supplied

Progressive osseous heteroplasia, uncommon cause of soft tissue ossification: a case report and review of the literature.

We report a case of an uncommon, recently described disease manifesting shortly after birth, characterized by extensive soft tissue calcification with ossification, progressive osseous heteroplasia. We describe the complex histopathologic patterns present in this case, discuss the main differential diagnoses that the surgical pathologist must consider when confronted by soft tissue ossification, and review the pertinent literature. We conclude that although the morphologic patterns of ossification in progressive osseous heteroplasia are complex and the involvement is extensive, the morphology of the lesions lacks diagnostic specificity. The diagnosis must be based on a consideration of the combined clinical data and radiologic and pathologic findings. This approach alone makes it possible to exclude a number of clinicopathologic entities that manifest with so-called osteoma cutis but whose associated lesions and genetic implications are different.

Calcinosis↗
PubMed1982

Recurrence of ectopic ossification after excision in Charnley Low Friction Arthroplasty.

In 23 hips with a Charnley Low Friction Arthroplasty (L.F.A.), revised for mechanical reasons, a planimeter was used to study areas of ectopic ossification and their recurrence after excision. In two cases some bone resorption had taken place. In the remaining 21 hips the average area of recurrence was greater than the average area excised. There was no correlation between the time elapsed and the extent of ossification; once established, the ossification did not seem to progress. Revision of L.F.A. for excision of ectopic bone is not indicated.

Adult↗
PubMed1999

Symptomatic ossification of the posterior longitudinal ligament of the lumbar spine. Case report.

The authors report a case of focal ossification of the posterior longitudinal ligament (OPLL) behind the L-3 vertebral body. This is relatively rare among previously reported cases in the literature. Magnetic resonance (MR) imaging revealed that the ossifying portion of the PLL was impinging on the left L-3 nerve root. Contrast enhancing hypertrophic PLL was also demonstrated around the ossification and along the lumbosacral PLL. Via a laminectomy and wide excision of the PLL the lesion was removed. Pathological examination revealed a nodule composed of fibrous cartilage, lamina bone, and mature fat marrow. Enchondral ossification could be identified under a microscope. The authors believe that preoperative MR imaging evaluation is important for the detection of the relationship between an OPLL and the neural structure. Excision of the symptomatic OPLL should be performed when needed to obtain adequate nerve root decompression.

Back Pain↗
PubMed2001

Thoracic spine arachnoid ossification with and without cord cavitation. Report of three cases.

Thoracic spine arachnoid ossification is a relatively rare disease that affects mainly women and causes sensory, motor, and sphinctal symptoms associated with inferior limb pain. Based on three cases, the authors comment on pathogenic and surgery-related aspects of the disease. The patient in Case 1 was followed over the course of 23 years. Spinal cavitation is highlighted in Case 2, and yellow, gross, half-ring ossification is described in Case 3. Calcium deposits usually occur in the middle and lower thoracic spine where the majority of trabeculated arachnoid cells are located. Operative treatment does not interrupt the ossification process, which continues over time, causing progressive deterioration in the patient. Spinal cavitation can occur due to spinal cord tethering, stretching, and central cord edema formation, accompanied by cerebrospinal fluid blockage and pulse pressure changes. The results of surgical intervention are poor, offering short-term recovery with later deterioration. Multiple pathogenic factors are involved in this clinical syndrome including metabolic changes.

Adult↗
PubMed1996

Heterotopic ossification.

Heterotopic ossification is a well-recognized condition frequently encountered by the orthopedic surgeon. Although typically asymptomatic, heterotopic ossification can be a complication of extreme severity. This article is a review of literature and attempts to clarify the definition, and delineates the etiology, incidence, risk factors, and current modes of prophylaxis and treatment of various types of heterotopic ossification.

Aged↗
PubMed1998

Post-traumatic heterotopic ossification about the elbow.

To evaluate the effect of surgical timing on the formation of heterotopic ossification about the elbow, 71 consecutive patients with elbow trauma requiring operative management were evaluated. Fourteen patients were excluded because they suffered from head injury, burns, or severe open injuries requiring surgery on two or more occasions. Sixteen patients were lost to follow-up, leaving a group of 41 patients. The average age of patients was 35 years. The fractures involved the olecranon in 19, distal humerus in 12, and radial head/neck in 10 patients. Six of these fractures were accompanied by a dislocation. Eleven were open injuries; the remaining 30 were closed. Bone grafting was performed in nine patients. The interval between injury and surgical intervention averaged 57 hours. None (0%) of 17 patients treated within 48 hours developed grade II, III, or IV heterotopic ossification, whereas 8 (33%) of 24 patients treated after 48 hours developed grade II, III, or IV heterotopic ossification. There were no significant differences in demographic or injury parameters between these two groups. These findings suggest that fixation of unstable elbow fractures within 48 hours of injury may reduce the formation of ectopic bone.

Adolescent↗
PubMed1999

General short-term indomethacin prophylaxis to prevent heterotopic ossification in total hip arthroplasty.

This prospective study evaluated heterotopic ossification prophylaxis with indomethacin for 14 days in 201 consecutive patients undergoing total hip arthroplasty. Ranitidine was administered concurrently to alleviate gastrointestinal side effects. None of the patients with mild gastrointestinal side effects (12%) had to suspend the prophylaxis, and no major postoperative bleeding or gastrointestinal ulcers were observed. After 12 months of follow-up, 67% of patients had no evidence of heterotopic ossification, 32% percent had grades I and 1% had grade III without clinical significance, and 0% had grade IV ossification according to Brooker's classification. These results indicate that short-term indomethacin prophylaxis is an effective, inexpensive, and easily administrated alternative to single-dose radiotherapy for nearly all patients undergoing THA.

Adult↗
PubMed1999

Excision and radiotherapy for heterotopic ossification of the elbow.

Radiotherapy has a well-defined role in prophylaxis of recurrent heterotopic ossification of the hip, but has been described infrequently in other situations. This article reports the use of excision and low-dose external beam radiotherapy in three patients with heterotopic ossification of the elbow treated between February 1995 and September 1996. Radiotherapy was delivered in a single fraction of 7-8 Gy within 48 hours postoperatively using opposed anteroposterior portals. After a median follow-up of 10.5 months, all three patients demonstrated a significant increase in range of motion without any evidence of recurrence. These results indicate adjuvant postexcision radiotherapy may be used for prophylaxis of recurrent heterotopic ossification of the elbow.

Adult↗
PubMed2001

Indomethacin versus radiation therapy for heterotopic ossification after hip arthroplasty.

This study compared the efficacy and cost of radiation therapy with indomethacin in the prophylaxis of heterotopic ossification following total hip replacement. Twenty-two patients received a radiation dose of 10 Gy in five fractions, 28 patients 8 Gy in one fraction, and 27 patients 25 mg oral indomethacin three times a day for either 7 or 21 days. Patients at higher risk for heterotopic ossification were more likely to receive radiation therapy than indomethacin. At a mean follow-up of 2 years, there were no differences in failure rates between the high-risk patients treated with radiation and the low-risk patients treated with indomethacin. Currently, the patient-billed cost of radiation is $1400 whereas the cost for indomethacin is approximately $100. Indomethacin appears to be as effective as radiation therapy in patients at low to moderate risk for heterotopic ossification and offers significant cost savings.

Adult↗
PubMed1978

Heterotopic ossification around the hip in spinal cord-injured patients. A long-term follow-up study.

Twenty patients with spinal cord injury complicated by ossification around the hip were followed for eighteen months or more. The bone scan, roentgenogram, level of alkaline phosphatase, and range of hip motion of each patient were analyzed. The average follow-up was forty months. The heterotopic ossification usually did not mature until after one and one-half years. The roentgenograms were of no value in judging its maturity. The bone scan correlated well with the results of the alkaline phosphatase testing in judging maturity of the ossification. We concluded that before operative resection, a patient should have a normal level of alkaline phosphatase, decreasing activity on the bone scans, and a restriction of motion to less than 50 degrees of hip flexion.

Adolescent↗
PubMed2000

[Pulmonary adenocarcinoma with central ossification].

A 70-year-old woman was admitted in April 1997 because a coin lesion in the left middle lung field was observed on chest roentgenograms. The lesion had slightly increased in size since 1994, when it was first pointed out. Chest computed tomography elucidated a high density area with irregular borders in the center of the shadow in S 3 a. Transbronchial biopsy revealed adenocarcinoma, and a left upper lobectomy was performed. The resected specimen demonstrated a tumor with central ossification and pleural indentation. Histologic examination determined that the the tumor was a papillary adenocarcinoma with central ossification containing marrow tissue. Primary lung cancer with central ossification is very rare, and only 6 cases have been reported to date, including this case.

Adenocarcinoma, Papillary↗
PubMed2000

Heterotopic ossification of the adductor longus muscle presenting as dyspareunia.

Dyspareunia after heterotopic ossification of the adductor longus is a rare complication. We describe a patient with symptomatic heterotopic ossification of the adductor muscle that developed years after sustaining a fracture of the inferior pubic ramus in association with an injury to the adductor longus muscle. The patient's pain was reduced and his dyspareunia resolved after excision of the adductor longus heterotopic ossification and subsequent physical therapy.

Adult↗
PubMed2001

Successful diagnostic and surgical hysteroscopy for endometrial ossification.

PURPOSE OF INVESTIGATION: Diagnostic-operative hysteroscopy was successful in two cases of endometrial ossification, and fertility was restored. METHODS: A 30-year-old and a 32-year-old woman presented at our Department with a history of secondary infertility, complaining of pelvic pain, dysmenorrhea and polymenorrhea which lasted for about one year before admission. Previous ultrasound studies revealed the presence of two bright hyperechogenic bands with posterior shadowing. RESULTS: In both cases diagnostic-operative hysteroscopies were performed, displaying osseous fragments which were removed with resectoscopy, mainly mechanically. CONCLUSION: Hysteroscopic resection should be the elective treatment for endometrial ossification because it allows complete removal of osseous fragments and reduces the chance of residual synechia. The mean objective of hysteroscopy in endometrial ossification is the restitution of conceivement capability.

Adult↗
PubMedDate not supplied

Preventive cobalt therapy in heterotopic ossification consequent to prosthetic hip reimplantation.

Prosthetic hip reimplantation is considered to be a procedure at risk for the development of periprosthetic heterotopic ossification, which may be responsible for functional limitations of the hip operated on. Preventive treatment may be carried out with radiation or drug therapy. The authors report the results of 54 cases submitted to prosthetic reimplantation and treated by cobalt therapy, as compared to the results of 76 reimplantations (control group) that did not undergo any kind of treatment: the occurrence of high grade ossification (exceeding Brooker grade III) was 2% in cases treated, as compared to 9% in those not treated. Males were more at risk for the development of ossification.

Adult↗
PubMedDate not supplied

Desmoplastic trichoepithelioma: the association with compound nevus and ossification.

We report two cases of desmoplastic trichoepithelioma. One case was associated with compound nevus and the other case with ossification. Desmoplastic trichoepithelioma and nevus cell nevus are assumed to be a combined malformation. In our case 1, clinical and histological findings indicate that nevus cell nevus preceded desmoplastic trichoepithelioma and the latter developed in the lesion of the former. Ossification was reported to be associated with desmoplastic trichoepithelioma in 6% of cases. However, case reports of this combination with a detailed description are extremely rare. We speculate that the mechanism of ossification in this tumor must be related to foreign-body reactions caused by ruptured horn cysts.

Adult↗