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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

Abstract

YOGESWARAN, C  and  OROKO, PK. Early excision of heterotopic ossification for pain control: A case report. SA orthop. j. [online]. 2015, vol.14, n.1, pp.52-55. ISSN 2309-8309.

BACKGROUND: Heterotopic ossification rarely presents with pain as the primary symptom CASE: A 31-year-old soldier presented with severe right hip pain 2.5 months after a craniectomy following a penetrating brain injury. Examination revealed a right-sided hemiplegia and a stiff hip with the patient resisting any passive movements due to severe pain. A hip X-ray confirmed massive heterotopic ossification of the right hip. Pain was so severe that he required management by the pain control team who administered analgesics including the use of several epidural catheters and femoral nerve blocks. There was also significant restriction in activity, including physiotherapy, due to pain. Exploration and excision of the heterotopic bone at the right hip 2.5 months after diagnosis revealed significant compression and stretching of the sciatic nerve by the heterotopic bone. The massive heterotopic bone was excised followed by radiotherapy using 800 cGy within 24 hours of surgery. Post-operatively pain control was significantly improved with only simple analgesics being required CONCLUSION: Heterotopic ossification at the hip can be associated with significant pain when compression of the sciatic nerve is involved. Early surgical excision is indicated, instead of waiting until maturity of heterotopic bone, for the main purpose of achieving pain control

Keywords : heterotopic ossification; traumatic brain injury; hip; nerve entrapment.

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