Treatment of symptomatic intercostal heterotopic ossification after surgical stabilization of rib fractures: report of two cases and review of the literature

Greiffenstein, Patrick; Adams, Emily; Scheuermann, Alexis; Rogers, Camille L.

doi:10.21037/jtd.2019.01.37

Cited by 5 publications

(10 citation statements)

References 12 publications

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“…Postoperative rib fixation complications may include wound infection, hardware failure, chronic pain, and empyema 5 . An extremely rare complication after rib fixation is the formation of intercostal HO progressing to rib synostoses, with only 3 cases previously reported in the literature 5,6 . The formation of rib synostoses is more common in individuals without rib fixation, with congenital malformations accounting for most cases 7 Although HO formation has been reported as a complication after surgical fixation of the upper and lower extremity, it is important to note that the relationship between surgical approaches and HO formation is unclear 5,6,[9][10][11][12] .…”

Section: Discussionmentioning

confidence: 99%

“…HO is the presence of lamellar bone in inappropriate locations, and the mechanism underlying its formation is poorly understood 4,6,9,[11][12][13] . Risk factors include trauma, traumatic brain and central nervous system injury, genetic disorders, and burns 4,6,9,[11][12][13] . The presence of HO may result in pain, joint ankylosis, and decreased ROM 6,9,[11][12][13] .…”

Section: Discussionmentioning

confidence: 99%

“…In addition, congenital rib HO excision has treated persistent dyspnea and chest wall pain in a young adult patient 7 . The exact frequency with which rib synostoses are treated with excision is not known, and how often excision leads to improvement in pulmonary function is not well documented 3,6,7 . To the best of our knowledge, this is the first report of intercostal HO excision and rib hardware removal as a successful treatment for compromised pulmonary function secondary to multilevel traumatic rib synostoses in a patient with polytrauma.…”

Section: Discussionmentioning

confidence: 99%

“…An extremely rare complication after rib fixation is the formation of intercostal HO progressing to rib synostoses, with only 3 cases previously reported in the literature 5,6 . The formation of rib synostoses is more common in individuals without rib fixation, with congenital malformations accounting for most cases 7 Although HO formation has been reported as a complication after surgical fixation of the upper and lower extremity, it is important to note that the relationship between surgical approaches and HO formation is unclear 5,6,[9][10][11][12] . Thus, it is uncertain to what degree our patient's extensive HO formation and resultant rib synostoses were caused by her post-MVC rib fixation surgery.…”

Section: Discussionmentioning

confidence: 99%

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Resection of Posttraumatic Rib Synostoses Resolves Pulmonary Insufficiency

Mavrommatis

Laroque

Cole

2022

JBJS Case Connector

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Case: A 30-year-old woman underwent open reduction and internal fixation for multiple segmental rib fractures status post a motor vehicle collision. A year later, the patient presented with extensive intercostal heterotopic ossification associated with multilevel, hemithoracic, rib synostoses compromising her ventilation. The patient subsequently underwent synostoses excision and hardware removal. Pulmonary function tests (PFT), imaging, and patient-reported outcome scores demonstrate resolution of impairment. Conclusion: Resection of multilevel, intercostal, rib synostoses provided an effective treatment for pulmonary restrictive disorder secondary to traumatic rib synostosis. This is the first patient with documentation of prereconstructive and postreconstructive PFTs for chest wall synostosis excision.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Resection of Posttraumatic Rib Synostoses Resolves Pulmonary Insufficiency

Mavrommatis

Laroque

Cole

2022

JBJS Case Connector

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“…When considering amputation in PF, one needs to consider the associated necrotic wet gangrene which significantly increases the need for amputation [19]. Conservative treatment of HO includes physical therapy, but when symptoms become too severe, it should be addressed with surgical excision of ossified tissue [20].…”

Section: Discussionmentioning

confidence: 99%

Development of Bilateral Heterotopic Ossification After Survival of Life Threatening Purpura Fulminans

Asif

Klifto

Lagziel

et al. 2020

Cureus

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Heterotopic ossification has been reported in patients who have undergone traumatic amputations, burn injuries, and total hip arthroplasty; however, the incidence of heterotopic ossification following purpura fulminans has only been reported in one case with unilateral involvement. Here we present a bilateral lower extremity case of heterotopic ossification as sequelae of purpura fulminans. A 34-year-old male smoker with a past medical history of stab wounds to the chest and abdomen requiring emergent exploratory laparotomy, diaphragmatic repair, and splenectomy 15 years ago presented to the emergency department with a rapid onset of high fevers, chills and myalgia. He did not receive post-splenectomy prophylactic vaccinations for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. The patient presented clinically in septic shock with disseminated intravascular coagulation. The patient was admitted to the Medical Intensive Care Unit and subsequent workup suggested Streptococcus pneumoniae bacteremia. Over the next 48 hours, the patient developed extensive necrosis of the bilateral upper and lower extremities concerning for purpura fulminans. The decision was made to perform a right transradial forearm amputation as well as bilateral transtibial amputations. He tolerated these procedures and was discharged to an inpatient rehabilitation facility. Approximately four months following his bilateral below knee amputations, the patient had difficulty wearing the prosthetics secondary to pain and eventually discontinued use altogether. At home, he continued to ambulate by bearing weight on his knees while wearing kneepads. He continued to report significant tenderness and pain along the bilaterally, below knee amputation stumps. His physical examination was concerning for significant distal bone formation in his bilateral amputation stump sites without evidence of skin breakdown. Intraoperatively, extensive bony formation was found bilaterally within his soleus muscle flaps, concerning for heterotopic ossification. Postoperatively, the patient was refitted for lower extremity prosthetics. Similar to burns and trauma, the development of heterotopic ossification in patients with purpura fulminans may be directly related to the inflammatory process and amount of tissue damage. In some cases, heterotopic ossification could be caused from daily living activities, so the timing of diagnostic imaging techniques and clinical intervention is crucial.

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