successful use of irradiation around the elbow to prevent recurrence (McAuliffe and Wolfson, 1997), although most of the related evidence is in heterotopic ossification of the hip, where it is commonly used. 7 Gy is the standard dose, with lower doses appearing to be less effective; however, there is concern that higher doses may increase the risk of second malignancy (RCR, 2015). Radiation side effects are also proportional to the volume of tissue treated, so it is likely that the small site treated in digits, as in our patient, posed very little risk of longterm damage.In conclusion, our case highlighted the potential use of low dose radiotherapy as an adjuvant therapy in the management of this very difficult condition, to prevent heterotopic ossification recurrence after failed revision surgery.

Background: A number of treatment options are available for diaphyseal non-unions of the tibia, including intramedullary (IM) nailing. An infrapatellar entry point with the knee in deep flexion can make this procedure challenging, especially with associated deformity or an obliterated canal. The suprapatellar approach allows nail insertion with the knee extended, which facilitates correction of malalignment in the sagittal and coronal planes. The aim of our study was to review the outcome of diaphyseal tibial non-unions, treated with an intramedullary nail, using the suprapatellar approach. Method: We retrospectively reviewed consecutive cases with non-union of the tibial shaft, treated with a suprapatellar entry nail between May 2016 and January 2018. Patients who were previously managed with a nail or who had active sepsis were excluded. The rate and time to union, as well as complications were assessed. Results: Thirteen cases were included and followed up until union at a mean of 5.8 months. All were performed percutaneously, without opening of the non-union site. Two patients developed complications, although bony union was still achieved. Conclusion: A suprapatellar entry tibial nail is an acceptable treatment option for tibial non-unions not previously treated with a nail.