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HETEROTOPIC OSSIFICATION 5-MINUTE ORTHOPAEDIC CONSULT
Presented by:Anggiat Humusor Ulina
C11107226
Advisor :
dr. Hendrian Chaniago
Suervisor:
dr. !arya "ri#o$ S. %". &!' Sine
Orthopedic dan Traumatology
Faculty of Medicine Hasanuddin University
Makassar
2011
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DESCRIPTION
Pathologi( bone )ormation as a(onse*uen(e o) dire(t trauma or
(entral nervous system in+uries ,one )ormed in heterotoi(
lo(ations su(h as mus(le$
sub(utaneous tissues$ or nerves -ost (ommonly o((urs at the
hi$ elbo$ and shoulder +oints
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EPIDEMIOLOGY
/ess (ommon in (hildren than inadults$ and more (ommon in males
than in )emales. n(iden(e:
%((urs in 1020 o) atients ith
(entral nervous system or traumati(in+uries$ ith an average onset o) 2months a)ter in+ury.
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THREE COMMON LOCATIONS OF
HETEROTOPIC OSSIFICATION AROUND
THE HIP JOINT
A: Anterolateral3anteromedial lo(ation4 ,: n)erior and medial lo(ation4and C: /o(ation around the )emoral ne(# and osterior.
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RISK FACTORS
Central nervous system in+ury %steoarthrosis
%steohyte )ormation Surgi(al aroa(h Previous surgi(al ro(edures "ro(hanteri( osteotomy
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ETIOLOGY
"raumati( brain in+ury
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DIAGNOSIS
Signs and SymtomsUne5lained in(rease in ain$ sasti(ity$ or
mus(le guarding
e(reased %-Sti))ness
adiograhi( eviden(e o) e(toi( bone
Physi(al 85am
/imited %- is the most (ommon and earliestsign.
8rythema$ selling$ and signs o) in)lammationalso may be noted.
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TESTS
/abSerum al#aline hoshatase levels are elevated.9alue begins to rise 2 ee#s a)ter in+ury.
maging%n lain radiograhs$ ne bone )ormation may be1st visible at 6 ee#s4 but radiograhs generallyare not (on)irmatory until months.
,one s(ans allo )or earlier dete(tion and sho
intense uta#e.C" may be used )or reoerative lanning and to
sho the ;onal attern: -inerali;ed in the eriheryand lu(ent in the (enter.
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EXTENSIVE
HETEROTOPIC
OSSIFICATION AT THE
MEDIAL ASPECT OF
THE LEFT KNEE
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TESTS
Pathologi(al
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DIFFERENTIAL DIAGNOSIS
Seti( +oint "hrombohlebitis
=eolasm in the so)t tissues
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TREATMENT
>eneral -easures?oint motion is maintained to allo normal )un(tioning.-ost atients are treated su((ess)ully ith
nonoerative measures$ in(luding hysi(al theray$analgesi(s$ and =SAs.
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MEDICATION
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SURGERY
Surgery is indi(ated to restore +oint motion or to(orre(t (ontra(tures in disabled atients$ it should notbe rese(ted earlier than 6 months a)ter in+ury.
85(ision a)ter 2 years in(reases the li#elihood o)
ermanent (ontra(tures. A)ter rese(tion$ atients are treated ith lo doses o)
irradiation &must be delivered ithin 72 hours'.
Some atients ele(t to ta#e =SAs &e.g.$
indometha(in' )or 6 ee#s a)ter rese(tion. astri( intoleran(e revents 10B20 o) atients )rom ta#ing
these medi(ations.
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FOLLOW-UP
PrognosisPrognosis varies$ deending onthe lo(ation o) heterotoi(ossi)i(ation and its (ause.
-ost atients ith nonneurogeni(
heterotoi( ossi)i(ation maintainreasonable )un(tion and do notre*uire surgi(al intervention.
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FOLLOW-UP
Comli(ations/oss o) mobility
An#ylosis Patient -onitoringSerial radiograhs are obtainedat 1 month intervals )or 6months.
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THANK YOU