Heterotopic Ossification Following Upper Extremity Injury

Agarwal, Shailesh; Loder, Shawn; Lévi, Benjamin

doi:10.1016/j.hcl.2016.12.013

Cited by 21 publications

(22 citation statements)

References 71 publications

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“…In literature, the optimal strategy for prevention of post-traumatic heterotopic ossifications is still a topic of debate. However, following the current major evidences [ 47 ], in order to minimize ectopic bone formation, non-steroid anti-inflammatories (indomethacin 25 mg; orally 3 times daily) should be administered at least for 3–4 weeks post-operatively [ 9 , 43 ].…”

Section: Introductionmentioning

confidence: 99%

How to approach Monteggia-like lesions in adults: A review

Calderazzi

Galavotti

Nosenzo

et al. 2018

Annals of Medicine and Surgery

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Monteggia-like lesions encompass a wide spectrum of fractures of the forearm and elbow associated with dislocations, subluxations and ligamentous lesions.Many attempts have been made to classify these injuries, not only to understand their pathology but also to develop optimal treatments.Unfortunately, although some of these classifications are complete, they are either complex, not immediately usable, or not exhaustive. An orthopedic surgeon who aims to rapidly treat this kind of injury needs a visual classification, and knowledge of the best surgical approach.Monteggia like lesions do not allow for mistakes during surgery, as even a minor error could be prove detrimental to performing and completing all surgical steps.In this paper, based on our extensive experience in treating these rare lesions, we suggest a practical guide to the best surgical approach for various types of Monteggia like lesions.Some technical tips and pitfalls are also described.

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Section: Introductionmentioning

confidence: 99%

How to approach Monteggia-like lesions in adults: A review

Calderazzi

Galavotti

Nosenzo

et al. 2018

Annals of Medicine and Surgery

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“…Elbow stiffness following peri-articular injury is a debilitating condition, precluding patients from performing activities from daily living. In order for individuals to perform 90% of their daily activities, such as bathing and eating independently, an arc of elbow motion of 100 degrees (30° extension to 130° flexion; 50° pronation to 50° supination) is necessary (Agarwal et al 2017 ). Furthermore, it has been reported that a decrease in arc of elbow motion of only 50%, results in an 80% loss of elbow function (Morrey et al 1981 ).…”

Section: Introductionmentioning

confidence: 99%

Novel preclinical murine model of trauma-induced elbow stiffness

et al. 2018

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BackgroundPeri-articular injury may result in functional deficits and pain. In particular, post-traumatic elbow stiffness is a debilitating condition, precluding patients from performing activities of daily living. As such, clinicians and basic scientists alike, aim to develop novel therapeutic interventions to prevent and treat elbow stiffness; thereby reducing patient morbidity. Yet, there is a paucity of pre-clinical models of peri-articular stiffness, especially of the upper extremity, necessary to develop and test the efficacy of therapeutics. We set out to develop a pre-clinical murine model of elbow stiffness, resulting from soft tissue injury, with features characteristic of pathology observed in these patients.MethodsA soft tissue peri-elbow injury was inflicted in mice using cardiotoxin. Pathologic tissue repair was induced by creating an investigator-imposed deficiency of plasminogen, a protease essential for musculoskeletal tissue repair. Functional testing was conducted through analysis of grip strength and gait. Radiography, microcomputed tomography, and histological analyses were employed to quantify development of heterotopic ossification.ResultsAnimals with peri-elbow soft tissues injury in conjunction with an investigator-imposed plasminogen deficiency, developed a significant loss of elbow function measured by grip strength (2.387 ± 0.136 N vs 1.921 ± 0.157 N, ****, p < 0.0001) and gait analysis (35.05 ± 2.775 mm vs 29.87 ± 2.075 mm, ***, p < 0.0002). Additionally, plasminogen deficient animals developed capsule thickening, delayed skeletal muscle repair, fibrosis, chronic inflammation, and heterotopic ossification; all features characteristic of pathology observed in patients with trauma-induced elbow stiffness.ConclusionA soft tissue injury to the peri-elbow soft tissue with a concomitant deficiency in plasminogen, instigates elbow stiffness and pathologic features similar to those observed in humans. This pre-clinical model is valuable for translational studies designed to investigate the contributions of pathologic features to elbow stiffness or as a high-throughput model for testing therapeutic strategies designed to prevent and treat trauma-induced elbow stiffness.Electronic supplementary materialThe online version of this article (10.1186/s40634-018-0155-3) contains supplementary material, which is available to authorized users.

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“…The formation of new bone through an endochondral process is an uncommon event in the postnatal life initiated by different triggers such as fractures, traumatic events, acute trauma, combat related injuries and severe burns [ 7 , 8 , 78 , 79 ]. Moreover, HO is a frequent complication of orthopedic surgeries, involving hip and elbow [ 5 , 9 , 10 , 11 ].…”

Section: Acquired Heterotopic Ossificationmentioning

confidence: 99%

Genetic and Acquired Heterotopic Ossification: A Translational Tale of Mice and Men

et al. 2020

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Heterotopic ossification is defined as an aberrant formation of bone in extraskeletal soft tissue, for which both genetic and acquired conditions are known. This pathologic process may occur in many different sites such as the skin, subcutaneous tissue, skeletal muscle and fibrous tissue adjacent to joints, ligaments, walls of blood vessels, mesentery and other. The clinical spectrum of this disorder is wide: lesions may range from small foci of ossification to massive deposits of bone throughout the body, typical of the progressive genetically determined conditions such as fibrodysplasia ossificans progressiva, to mention one of the most severe and disabling forms. The ectopic bone formation may be regarded as a failed tissue repair process in response to a variety of triggers and evolving towards bone formation through a multistage differentiation program, with several steps common to different clinical presentations and distinctive features. In this review, we aim at providing a comprehensive view of the genetic and acquired heterotopic ossification disorders by detailing the clinical and molecular features underlying the different human conditions in comparison with the corresponding, currently available mouse models.

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Heterotopic Ossification Following Upper Extremity Injury

Cited by 21 publications

References 71 publications

How to approach Monteggia-like lesions in adults: A review

How to approach Monteggia-like lesions in adults: A review

Novel preclinical murine model of trauma-induced elbow stiffness

Genetic and Acquired Heterotopic Ossification: A Translational Tale of Mice and Men

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