Heterotopic Ossification

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Abstract
Patients with traumatic spinal cord injuries frequently suffer the complication of heterotopic ossification in the soft tissues around paralyzed joints. Careful roentgenographic surveys have shown an incidence of 20 to 25 per cent with approximately one-third of these patients significantly restricted in joint motion or ankylosed.7 Typical bilateral involvement is illustrated in Figures 1 and 2. Full range of joint motion is especially important if maximum independence is to be achieved by rehabilitation. Sitting, lower extremity dressing, transfers between bed and chair and perincal care are but a few of the major areas in which free range of motion is essential. Knowledge of the process of heterotopic ossification and its management is, therefore, essential. Male patients under 25 years of age are most frequently found to have heterotopic ossification following a spinal cord injury. Hips and knees are most commonly involved although the spine and all major joints in the upper extremity have been observed to develop this complication. Heterotopic ossification has only been observed within the area of neurological deficit unless other major injuries, such as extensive burns, were present.7 Patients with both complete and incomplete spinal cord injuries have developed heterotopic ossification. Reports of heterotopic ossification associated with tetanus, polio, strokes and other illnesses can be found in the literature. The exact etiology of this complication is unknown. Theories of overly enthusiastic ranging of the joints by the physical therapist have not been confirmed by critical reviews of patient records. Hormonal influence is suggested by the increased incidence of male paraplegic involvement but no biochemical studies have been done to confirm or deny a hormonal imbalance.

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