Heterotopic Ossification at an Unusual Site: A Case Report

  • Jessica Kaushal Government Medical College, Amritsar, Punjab, India,
  • Abhimanyu Rakesh SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India
  • Postgraduate Institute of Medical Education and Research, Chandigarh, India Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • Sanya Vermani Mirchia’s Diagnostic Center, Panchkula, Haryana, India
  • Lalit Kaushal Mother Teresa Saket Orthopedic Hospital, Panchkula, Haryana, India
Keywords: Heterotopic ossification, Neurogenic heterotopic ossification, Traumatic brain injury

Abstract

Heterotopic ossification (HO) is the formation of ectopic bone at non-physiological location, such as soft tissues around a joint. HO is a common complication seen after trauma and certain surgeries (e.g., total hip arthroplasty) involving specific regions such as hip. In neurogenic HO, ectopic bone develops in patients sustaining a spinal cord injury or traumatic brain injury (incidence 20–30%). Neurogenic HO characteristically involves major joints with hip joint being the most common, followed by elbow, shoulder, and knee joint. No reported case of HO in wrists, ankles, legs, and feet has been documented, making these highly rare locations. The ectopic bone may be asymptomatic or can cause significant functional impairment of the involved joint presenting as erythema, warmth, swelling with loss of range of motion; however, this case is a rare presentation involving ankle joint with no signs of inflammation. Plain X-rays and CT scans diagnose the new bone. Management involves primary prophylaxis with NSAIDs, bisphosphonates (not commonly used), and radiation therapy. Surgical excision is the definitive treatment. Neurogenic HO cases should undergo comprehensive and extended follow-up with attention to even rarely involved sites such as ankle, wrists, hands, and feet.

Author Biographies

Jessica Kaushal, Government Medical College, Amritsar, Punjab, India,

MBBS Intern, Department of Orthopedics

Abhimanyu Rakesh, SGRD Institute of Medical Sciences and Research, Amritsar, Punjab, India

 MBBS, Department of Orthopedics

Postgraduate Institute of Medical Education and Research, Chandigarh, India, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Senior Resident, Department of Orthopedics

Sanya Vermani, Mirchia’s Diagnostic Center, Panchkula, Haryana, India

Consultant Radiologist

Lalit Kaushal, Mother Teresa Saket Orthopedic Hospital, Panchkula, Haryana, India

Medical Superintendent and Head, Department of Orthopedics

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Published
2021-09-29