Severe myositis ossificans in a paraplegic trauma patient: Influence in pressure sore management

Abstract

Myositis ossificans (MO) is a benign, progressive, ossifying lesion that displays a characteristic zonal histological appearance. MO traumatica is a localized form of heterotopic bone formation, associated with repetitive micro-and/or macrotrauma in the majority of cases. The importance of imaging to differentiate MO from sarcomatous change and to determine maturity of the lesion is identified because suboptimal operative intervention on immature MO inevitably results in recurrence. A severe case of MO in a 24-year-old paraplegic man with chronic bilateral greater trochanteric pressure sores is presented, and the importance of the MO in the etiology and treatment of this case is discussed. An extensive review of the literature is included and integrated.Key Words: Heterotopic ossification; Myositis ossificans; Paraplegic; Pressure sore Myosite ossifiante sévère chez un polytraumatisé paraplégique : Influence du traitement des escarres de décubitus La myosite ossifiante (MO) est une lésion progressive bénigne caractérisée par son aspect histologique circonscrit. La MO traumatique est une forme localisée de formation osseuse hétérotopique associée à un microet/ou macrotraumatisme dans la majorité des cas. L'importance de l'imagerie pour différencier la MO d'une lésion sarcomateuse et pour déter-miner la maturité de la lésion est à souligner puisqu'une intervention chirurgicale stratégique suboptimale sur une MO immature entraîne inévitablement la récurrence. Un cas sévère de MO chez un paraplégique de 24 ans présentant des escarres de décubitus trochantériennes bilatérales chroniques est présenté ici. On aborde en outre l'importance de la MO dans l'étiologie et le traitement de ce cas. L'article propose aussi une revue complète de la littérature.A 24-year-old trauma patient, paraplegic secondary to a gunshot wound at the T5 level, was referred to the Plastic Surgery Division of the McGill University Hospital Center with grade IV bilateral trochanteric pressure sores. During the investigation, the presence of severe, left-sided pelvic myositis ossificans (MO) resulting in a fixed flexion contracture of the hip was noted. The patient had severe pain and spasm on leg extension and was unable to sleep or rest in a supine position. The radiological findings were consistent with MO. It was clear that this underlying problem had to be addressed simultaneously to provide definitive treatment of the trochanteric pressure sores. A review of the literature and details of the investigation of this specific case are provided.