Heterotopic Ossification Following Upper Extremity Injury

Abstract

Heterotopic ossification (HO) presents a substantial barrier to rehabilitation for patients with severe burns or trauma. Although surgical excision is a mainstay of management for this condition, this is unable to address the chronic sequelae of HO, including chronic pain, joint contractures, nerve dysfunction, and open wounds. Current therapeutic modalities are aimed at excision and the prevention of recurrence using nonsteroidal antiinflammatory drugs (NSAIDs) or radiation therapy. Research is now focused on identifying alternative strategies to prevent the initial occurrence of HO through NSAIDs and novel inhibitors of the bone morphogenetic protein signaling pathway.

Keywords: Burn injury; Elbow; Heterotopic ossification; Upper extremity.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Operative photographs and radiography demonstrating heterotopic ossification present in the soft tissue of the wrist.

Figure 2

Single-photon emission computed tomography (SPECT) demonstrating areas of uptake in a pre-osseous HO lesion of the right elbow (red box).

Figure 3

Raman spectroscopy identifies distinct peaks for mineral, lipid, and protein in early/developing HO lesions. Modified from Peterson JR, Okagbare PI, De La Rosa S, et al. Early detection of burn induced heterotopic ossification using transcutaneous Raman spectroscopy. Bone. 2013;54(1):30; with permission.

Figure 4

An approach to surgical and non-surgical management of heterotopic ossification.

Figure 5

Histologic progression of heterotopic ossification in a mouse model recapitulates the process of endochondral ossification.

Figure 6

Cox-2 inhibitors decrease the formation of heterotopic ossification in a murine burn-trauma model.