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J Am Acad Orthop Surg, Vol 17, No 11, November 2009, 689-697.
© 2009 the American Academy of Orthopaedic Surgeons
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Heterotopic Ossification Following Traumatic Brain Injury and Spinal Cord Injury

Cara A. Cipriano, MD, Stephan G. Pill, MD, MSPT and Mary Ann Keenan, MD

Dr. Cipriano is Resident, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL. Dr. Pill is Resident, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA. Dr. Keenan is Chief of the Neuro-Orthopaedics Program, Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania.

Dr. Keenan or a member of her immediate family has received research or institutional support from Stryker, has stock or stock options held in Zimmer, and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from the Journal of Bone and Joint Surgery American and McGraw-Hill Publishers. Neither of the following authors nor a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Cipriano and Dr. Pill.

Reprint requests: Dr. Keenan, Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce Street, 2 Silverstein, Philadelphia, PA 19104.

Heterotopic ossification associated with neurologic injury, or neurogenic heterotopic ossification, tends to form at major synovial joints surrounded by spastic muscles. It is commonly associated with traumatic brain or spinal cord injury and with other causes of upper motor neuron lesions. Heterotopic ossification can result in a variety of complications, including nerve impingement, joint ankylosis, complex regional pain syndrome, osteoporosis, and soft-tissue infection. The associated decline in range of motion may greatly limit activities of daily living, such as positioning and transferring and maintenance of hygiene, thereby adversely affecting quality of life. Management of heterotopic ossification is aimed at limiting its progression and maximizing function of the affected joint. Nonsurgical treatment is appropriate for early heterotopic ossification; however, surgical excision should be considered in cases of joint ankylosis or significantly decreased range of motion before complications arise. Patient selection, timing of excision, and postoperative prophylaxis are important components of proper management.






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Copyright © 2009 by the American Academy of Orthopaedic Surgeons.