Heterotopic Ossification Following Arthroplasty for Femoral Neck Fracture.

BACKGROUND: Heterotopic ossification (HO) is a frequent complication following hip surgery. Using data from the Hip Fracture Evaluation with Alternatives of Total Hip Arthroplasty versus Hemiarthroplasty (HEALTH) trial, we aimed to (1) determine the prevalence of HO following total hip arthroplasty (THA) for femoral neck fracture in patients ≥50 years of age, (2) identify whether HO is associated with an increased risk of revision surgery within 24 months after the fracture, and (3) determine the impact of HO on functional outcomes. METHODS: We performed a multivariable Cox regression analysis using revision surgery as the dependent variable and HO as the independent variable. We compared Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between participants with and those without HO at 24 months. RESULTS: Of 1,441 participants in the study, 287 (19.9%) developed HO within 24 months. HO was not associated with subsequent revision surgery. Grade-III HO was associated with statistically significant and clinically relevant deterioration in the total WOMAC score, which was mainly related to the function component of the score, compared with grade I or II. CONCLUSIONS: The impact of grade-III HO on the functional outcomes and quality of life after THA for hip fracture is clinically important, and HO prophylaxis for selected high-risk patients may be appropriate. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Diagnosis and treatment of infraspinatus tendon-bursa ossification in a Eurasian Dog.

A 4-year-old male Eurasian Dog presented at our veterinary clinic with a history of perpetual forelimb lameness in both thoracic limbs. In the clinical exploration, direct pressure over the infraspinatus tendon of insertion caused pain in both thoracic forelimbs and a firm band-like structure was palpable. No improvement was observed after treatment with rest, non-steroidal anti-inflammatory drugs and an intralesional injection of a long-acting glucocorticoid. Radiographic examination, ultrasonographic exploration and computed tomography were performed, identifying ossified structures lateral to the proximal humerus and an irregular roughened periosteum at the insertion and tendon of the infraspinatus muscle on both sides. There were more distinct alterations on the right thoracic limb. The imaging results led to a diagnosis of an infraspinatus tendon-bursa ossification accompanied by a chronic tendinopathy/tendovaginitis, accentuated on the right side. The dog was subjected to physiotherapy and autologous conditioned plasma (ACP) was injected into the insertion of the infraspinatus muscle of both thoracic limbs. After 5 months of physiotherapy and two injections of ACP with an interval of one week in both forelimbs, the dog showed no signs of lameness. This case report describes the diagnosis and management of infraspinatus tendon-bursa ossification in a Eurasian Dog. To the authors' knowledge, this condition has previously not been described in this breed of dog.

Eagle syndrome revisited: cerebrovascular complications.

Cervical pain caused by the elongation of the styloid process (Eagle syndrome) is well known to otolaryngologists but is rarely considered by vascular surgeons. We report two patients with cerebrovascular symptoms of Eagle syndrome treated in our medical center in the past year. Case 1: an 80-year-old man with acromegaly presented with dizziness and syncope with neck rotation. The patient was noted to have bilateral elongated styloid processes impinging on the internal carotid arteries. After staged resections of the styloid processes through cervical approaches, the symptoms resolved completely. Case 2: a 57-year-old man presented with acute-onset left-sided neck pain radiating to his head immediately after a vigorous neck massage. Hospital course was complicated by a 15-minute transient ischemic attack resulting in aphasia. Angiography revealed bilateral dissections of his internal carotid arteries, with a dissecting aneurysm on the right. Both injuries were immediately adjacent to the bilateral elongated styloid processes. Despite immediate anticoagulation therapy, he experienced aphasia and right hemiparesis associated with an occlusion of his left carotid artery. He underwent emergent catheter thrombectomy and carotid stent placement, with near-complete resolution of his symptoms. Elongated styloid processes characteristic of Eagle syndrome can result in both temporary impingement and permanent injury to the extracranial carotid arteries. Although rare, Eagle syndrome should be considered in the differential diagnosis in patients with cerebrovascular symptoms, especially those induced by positional change.

Improvement of mouth opening for a patient with fibrodysplasia ossificans progressiva: a case report.

The aim of this article is to describe the care of a patient with fibrodysplasia ossificans progressiva (FOP) and to provide dentists with a guide for how to safely care for patients with FOP. Treatment improved the patient's limited mouth opening. FOP is a rare autosomal dominant disorder characterized by congenital malformation of the fingers and toes by heterotopic ossification progressiva of the connective tissue. This ossification causes a limitation in osteoradicular mobility, mainly affecting the spine, shoulders, hips, and peripheral joints. The disease can manifest from pregnancy until adulthood, with no greater prevalence associated with race or gender. Although rare, the disease can be easily identified by its clinical features, and diagnosis can be confirmed by a radiographic examination. There is no known effective treatment for this disease. All therapeutic treatment must be conservative to avoid any condition that may cause heterotopic ossification. Guidelines to prevent new ossifications are important for patients with FOP. Dental professionals should be cautious in planning treatment, avoiding anesthesia, especially in the mandible, to prevent ankylosis of the temporo-mandibular joints. The prevention of dental caries is essential to avoid the need for more invasive treatment.

Acquired plate-like osteoma cutis.

Plate-like osteoma cutis is a rare disorder that has been historically classified as a congenital syndrome. It has a possible relationship to a mutation in the gene (GNAS1) that encodes the α-subunit of the stimulatory G protein, which regulates adenyl cyclase activity. We report a case of extensive plaque-like masses on the scalp and face with no abnormalities in calcium or phosphate metabolism and no preceding inflammatory cutaneous conditions. With less than ten reported cases, to our knowledge, this is one the few cases of acquired plate-like osteoma cutis described in the literature.

Estimulacao elétrica neuromuscular na reversao da ossificacao heterotópica / Neuromuscular electric stimulation in heterotropic ossification regression

A ossificacao heterotópica é uma complicacao freqüente após a lesao medular. Os avancos graduais no campo da fisiopatologia, reabilitacao e novos métodos de tratamento sao uma esperanca para a reversao do quadro clínico do lesado medular num futuro próximo. O objetivo desse estudo é avaliar a resposta da ossificacao heterotópica das articulacoes coxo femorais à estimulacao elétrica neuromuscular em pacientes tetraplégicos após trauma raquimedular. Seis pacientes foram submetidos à estimulacao elétrica neuromuscular por um período médio de 16,6 meses, sendo avaliados radiologicamente. Foi identificada a melhora radiológica em dois pacientes e a nao progressao do quadro nos demais. A estimulacao elétrica neuromuscular em lesados medulares pode ser um método válido no tratamento da ossificacao heterotópica e prevencao de sua progressao.

Influence of brain injury on early posttraumatic bone metabolism.

BACKGROUND: Various clinical studies and observations demonstrate enhanced osteogenesis in patients sustaining traumatic brain injury. It is presumed that the induction of this process starts early after trauma. The purpose of our study was to investigate humoral markers of bone metabolism during the early posttraumatic period, with special regard to traumatic brain injury. METHODS: Serum concentrations of biochemical markers of bone metabolism (calcium, inorganic phosphorus, carboxyl-terminal propeptide of type 1 procollagen, pyridinoline cross-linked telopeptide domain of type 1 collagen, Ostase, osteocalcin, intact parathyroid hormone, and calcitonin) were measured in three different groups of 80 patients during the first posttraumatic week. Patients were categorized into three groups: group I, fractures only; group II, isolated traumatic brain injury; and group III, traumatic brain injury in combination with fractures. RESULTS: Osteocalcin levels were significantly lower in the presence of traumatic brain injury (p < .05). Elevated pyridinoline cross-linked telopeptide domain of type 1 collagen levels expressed enhanced bone resorption in all groups, but levels were significantly higher in the absence of traumatic brain injury (p < .05). Intact parathyroid hormone levels were significantly higher on days 0 and 1 in the combined presence of traumatic brain injury plus fractures. CONCLUSION: These results demonstrate an imbalance of bone formation and resorption parameters in patients with traumatic brain injury during the early posttraumatic period, suggesting a central regulation in bone formation. The lower levels of osteocalcin detected in this study may play an important role in patients with brain injury and the later development of posttraumatic heterotopic ossification.

Síndrome de Eagle: caso clínico y revisión bibliográfica / Eagle's syndrome: clinical case and bibliographic review

Se presenta el caso de paciente de sexo femenino con una calcificación sintomática del Ligamento Estilohioideo, patología diagnosticada bajo el nombre de Síndorme de Eagle. Los síntomas asociados se pueden confundir con una Patología Disfuncional Temporomandibular por lo cual el diagnóstico específico determinado por un detallado examen clínico y un importante análisis de los exámenes imagenológicos permitirán diferenciar patologías que su manejo clínico y terapias son particulares en cada caso