Ectopic Bone Formation in Children and Adolescents with Head Injuries

Mital, Mohinder A.; Garber, John E.; Stinson, John T.

doi:10.1097/01241398-198701000-00017

Cited by 52 publications

(24 citation statements)

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“…HO frequently complicates central nervous system disorders such as brain and spinal cord injuries, tumors, and encephalitis. [3][4][5][6][7][8] The use of nonsteroidal anti-inflammatory drugs (NSAID), particularly indomethacin, is generally accepted both for the prevention and treatment of HO following nerve injury and major hip surgery. 9 NSAID inhibit the differentiation of mesenchymal cells into osteogenic cells and suppress the post-traumatic prostaglandin-mediated inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Free radical scavengers are more effective than indomethacin in the prevention of experimentally induced heterotopic ossification

Bossche

Maele

Wojtowicz

et al. 2006

Journal Orthopaedic Research

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The pathogenesis of heterotopic ossification is still unclear and the preventive therapies are usually insufficient. The present study was designed to investigate the possible preventive effect of free radical scavengers on the development of experimentally induced heterotopic ossification in a rabbit model and to compare free radical scavengers with indomethacin to determine whether they act synergistically. A standard immobilization-manipulation model was used to induce heterotopical ossification in the hind legs of 40 1-year-old female New Zealand albino rabbits. The animals were divided into four groups and received daily either placebo, a free radical scavenger cocktail [allopurinol and N-acetylcysteine (A/A)], indomethacin or the combination of A/A and indomethacin in a randomized double-blind fashion. Every 4 days an X-ray was taken and the thickness and length of new bone formation was measured at the thigh. A marked statistically significant difference was found between the four groups. In the groups that received A/A, either alone or combined with indomethacin, an inhibition of bone growth, both in thickness and in length was demonstrated. In this experimental model free radical scavengers had a superior inhibitory effect on heterotopic ossification than indomethacin. Free radicals could play an important role in the pathogenesis of heterotopic ossification. ß

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Section: Introductionmentioning

confidence: 99%

Free radical scavengers are more effective than indomethacin in the prevention of experimentally induced heterotopic ossification

Bossche

Maele

Wojtowicz

et al. 2006

Journal Orthopaedic Research

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“…The authors reported recurrence in patients treated with excision and no adjuvant treatment. Although sodium etidronate and salicylates were administered in other patients, the results were not satisfactory [16].…”

Section: Discussionmentioning

confidence: 92%

“…The reported incidence for HO is ∼ 10-20% for traumatic brain injury to 20% for spinal chord injury in adults [12][13][14]. The incidence in the pediatric population reported ranges from 4 to 15% in traumatic brain injury [15,16] and from 8 to 10% in spinal cord injury [5,15].…”

Section: Discussionmentioning

confidence: 96%

Postencephalitic bilateral heterotopic ossification of the hip in a pediatric patient

Mohanty¹,

Rao²,

Dash

et al. 2015

Journal of Pediatric Orthopaedics B

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Heterotrophic ossification has been defined as abnormal formation of mature lamellar bone in soft tissues. Neurogenic heterotopic ossification has been well described in adults. However, it is uncommon in the pediatric population, where it has been noted to recede in some cases. There are very few reports of postmeningitis bilateral involvement of the hip. We describe a case of bilateral heterotopic ossification of hip in a 13-year-old female. The patient had a history of encephalitis, prolonged vegetative state, and intubation for 6 weeks. The patient had fixed deformities of both hips in 30° of flexion and 30° of external rotation. A diagnosis of Brooker stage 4 heterotopic ossification was made. The patient underwent a staged procedure for excision of the heterotopic mass. Postoperatively, the patient was administered radiotherapy and indomethacin for 6 weeks. At the 2-year follow-up, there was no recurrence and both the hips were mobile with full range of motion. The patient was satisfied with the result. The incidence of heterotopic ossification is less than that observed in the adult population and alkaline phosphatase levels are not significantly elevated unlike in adults. To our knowledge, there is no reported case of postencephalitic bilateral anterior heterotopic ossification of the hip in a pediatric patient treated with excision successfully. Postencephalitic heterotopic ossification in children is an uncommon condition. This condition can be treated successfully with surgical excision, combined postoperative protocol of radiotherapy, indomethacin, and immediate postoperative mobilization of the joint.

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“…In most instances the symptoms are not severe enough to warrant excision [8]. Furthermore resection of PHO almost invariably results in recurrence [6,9,11]. This is not surprising, since the individual's tendency to react with a bone-forming response to surgical trauma seems to be the most important factor in the development of PHO [8,17].…”

Section: Discussionmentioning

confidence: 98%

Nonsteroid anti-inflammatory drugs prevent the recurrence of heterotopic ossification after excision

Sodemann

Persson

Nilsson

1990

Arch Orthop Trauma Surg

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The prophylactic effect of nonsteroid anti-inflammatory drugs on the recurrence of high-grade periarticular heterotopic ossification after resection was studied in ten patients operated on for loosening of one or both components of a cemented total hip prosthesis. These drugs, given at a standard dosage for 1-3 weeks after surgery, prevented the recurrence of heterotopic ossification. In some patients the range of motion of their joint increased following surgery, while it remained unaffected in the majority. At follow-up 2-5 years after surgery, all patients walked well and there were no clinical or radiographs signs of loosening of the prosthetic components. It is concluded that treatment with NSAIDs following resection of periarticular heterotopic ossification prevents recurrence.

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Ectopic Bone Formation in Children and Adolescents with Head Injuries

Cited by 52 publications

References 0 publications

Free radical scavengers are more effective than indomethacin in the prevention of experimentally induced heterotopic ossification

Free radical scavengers are more effective than indomethacin in the prevention of experimentally induced heterotopic ossification

Postencephalitic bilateral heterotopic ossification of the hip in a pediatric patient

Nonsteroid anti-inflammatory drugs prevent the recurrence of heterotopic ossification after excision

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