Pediatric Heterotopic Ossification: A Comprehensive Review

Abstract

Purpose of Review The purpose of this review is to provide a comprehensive analysis of heterotopic ossification (HO) in pediatric patients, including an in-depth examination of the risk factors associated with this condition, current prophylactic measures, and available management strategies. Recent Findings HO is a medical disorder in which bone tissue inexplicably develops in soft tissues such as muscles and tendons. It involves the formation of mature, lamellar bone in extra-skeletal soft tissue, and its formation is influenced by oxygen tension, pH, the availability of micronutrients, and mechanical stimulation. HO has many cellular origins, with the most common theory being multipotent cells in local tissue. The diagnosis of HO is typically made based on exam, radiographs, and CT. Management includes both prophylactic nonsurgical options and surgical resection for severe or recalcitrant cases. Summary The review highlights the incidence, risk factors, and management strategies associated with HO in pediatric patients. HO is a rare condition in children, with severe neurologic injury being the most common cause. Pediatric patients most commonly develop HO following severe neurologic injury, followed by trauma and surgery. Current prophylactic measures, include nonsteroidal anti-inflammatory drugs and radiation therapy though limited literature on their use in the pediatric population exists. For recalcitrant symptomatic cases, wide surgical resection can be considered but has a higher risk profile and associated morbidity. This review highlights the need for further pediatric specific research to inform guidelines and management strategies for this debilitating condition.

Heterotopic ossification of the elbow joint in a child: Successful surgical resection - A case report

“…Elbow HO is rare in children [ 21 ], which presents a challenge for pediatric orthopedic surgeons to diagnose and treat. Improper treatment can lead to elbow bone malformation and affect elbow function in children.…”

Musculoskeletal Issues in Pediatric Burn Patients

“…The cause of this complication remains unclear. [31][32][33] In adults with burn injuries, risk factors for HO include increased percent total body surface area burn and grafting procedures to the arm, trunk, head, and neck. 34 No such data have been reported for children.…”

“…[36][37][38] Nonsteroidal anti-inflammatory drugs and radiation therapy have been used as adjuncts in the management of HO, particularly after surgery in other clinical scenarios. 32,33,39,40 There are sparse data about their use in burn-injury-related HO. 41 A severe burn injury results in a child losing both bone and muscle mass for a variety of reasons, including the catabolic stress response to injury, nutritional challenges, as well as immobilization for their burn management.…”