Post‐Traumatic Heterotopic Ossification: An Old Problem in Need of New Solutions

Abstract

Heterotopic ossification (HO) is the formation of pathological bone in ectopic sites and it can have serious consequences for functional outcomes. For many years, its main clinical relevance was as a rare complication of elective joint arthroplasty or CNS injury and a number of prophylaxes were developed to mitigate against it in these settings. As a consequence of changes in patterns of wounding and survival in conflicts since the turn of the century, post-traumatic HO has become much more common and case severity has increased. It represents one of the main barriers to rehabilitation in a large cohort of combat-injured patients. However, extant prophylaxes have not been shown to be effective or appropriate in this patient cohort. In addition, the lack of reliable early detection or means of predicting which patients will develop HO is another barrier to effective prevention. This review examines the current state of understanding of post-traumatic HO including the historical context, epidemiology, pathophysiology, clinical issues, currently prophylaxis and detection, management, and potential future approaches. Our aims are to highlight the current lack of effective means of early detection and prevention of HO after major trauma and to stimulate research into novel solutions to this challenging problem. ß

MiR‐19b‐3p regulates osteogenic differentiation of PDGFRα+ muscle cells by specifically targeting PTEN

“…Acquired HO is more common amongst patients with combat injuries (radiological evidence in 60-64% of patients), complex elbow fractures (43%), acetabular fractures (14-90%), total hip replacement (6-50%), traumatic brain injury (TBI) (10-40%), and spinal cord injury (5-60%) (Shukla et al, 2015;Eisenstein et al, 2018). Genetic HO is rare and commonly seen in fibrodysplasia ossificans progressiva and progressive osseous heteroplasia.…”

“…Genetic HO is rare and commonly seen in fibrodysplasia ossificans progressiva and progressive osseous heteroplasia. Acquired HO is more common amongst patients with combat injuries (radiological evidence in 60-64% of patients), complex elbow fractures (43%), acetabular fractures (14-90%), total hip replacement (6-50%), traumatic brain injury (TBI) (10-40%), and spinal cord injury (5-60%) (Shukla et al, 2015;Eisenstein et al, 2018). The only currently effective treatment for HO is surgical resection.…”

“…In addition, some patients are prone to recurrence after surgery, and the risks associated with operation also exist. Therefore, it is helpful to understand the mechanism of pathologic bone formation for preventing HO formation (Davis et al, 2018;Eisenstein et al, 2018). Although the definite pathogenesis of HO remains unclear, several factors that may contribute to this process have been identified.…”

Mkx-Deficient Mice Exhibit Hedgehog Signaling–Dependent Ectopic Ossification in the Achilles Tendons

“…Heterotopic ossification (HO) is the pathological formation of bone in soft tissues such as muscle, tendon, and ligaments . Clinically, the most common form of HO occurs following traumatic injuries or orthopedic surgeries, for which ossification is often not detected clinically until months after the traumatic events although the pathogenic processes likely started soon after injury and the underlying pathogenic mechanisms are not understood . Patients with HO experience a wide range of problems, including chronic pain, limitation in range of motion, joint ankyloses, and skin ulceration .…”

“…(2)(3)(4) Patients with HO experience a wide range of problems, including chronic pain, limitation in range of motion, joint ankyloses, and skin ulceration. (4) Currently, the primary treatment modality for HO, besides conservative management approaches including physical therapy and use of systematic nonsteroidal antiinflammatory drugs, is surgical excision of the ectopic bone. However, the efficacy of surgical excision is controversial because recurrences have been reported in many patients.…”