Botolin Sergiu, Mauffrey Cyril, Hammerberg E Mark, Hak David J, Stahel Philip F
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA.
J Med Case Rep. 2013 Apr 4;7:90. doi: 10.1186/1752-1947-7-90.
Heterotopic ossification is a rare complication of musculoskeletal injuries, characterized by bone growth in soft tissues. Percutaneous antegrade intramedullary nailing represents the 'gold standard' for the treatment of femur shaft fractures. Minor bone growth is frequently seen around the proximal end of reamed femoral nails (so-called 'callus caps'), which are asymptomatic and lack a therapeutic implication. The occurrence of excessive, symptomatic heterotopic ossification around the entry site of an antegrade femoral nail is rarely described in the literature.
We present the case of a 28-year-old Caucasian woman who developed extensive heterotopic ossification around the reaming seeds of a reamed femoral nail. She developed severe pain and significantly impaired range of motion of the hip joint, requiring revision surgery for heterotopic ossification resection and adjunctive local irradiation. She recovered full function of the hip and remained asymptomatic at her two-year follow-up appointment.
Severe heterotopic ossification represents a rare but potentially detrimental complication after percutaneous femoral nailing of femur shaft fractures. Diligent care during the reaming procedure, including placement of a trocar to protect from osteogenic seeding of the soft tissues, may help decrease the risk of developing heterotopic ossification after reamed antegrade femoral nailing.
异位骨化是肌肉骨骼损伤的一种罕见并发症，其特征是软组织内出现骨生长。经皮顺行髓内钉固定术是股骨干骨折治疗的“金标准”。在扩髓股骨髓内钉近端周围经常可见少量骨生长（所谓的“骨痂帽”），这些骨生长无症状且无治疗意义。文献中很少描述顺行股骨髓内钉进针部位周围出现过度的、有症状的异位骨化情况。
我们报告一例28岁白种女性病例，该患者在扩髓股骨髓内钉的扩髓导针周围出现广泛异位骨化。她出现严重疼痛，髋关节活动范围明显受限，需要进行手术翻修以切除异位骨化并辅助局部放疗。她的髋关节功能完全恢复，在两年的随访中无症状。
严重异位骨化是股骨干骨折经皮股骨钉固定术后一种罕见但可能有害的并发症。在扩髓过程中仔细操作，包括放置套管针以防止软组织发生骨源性种植，可能有助于降低扩髓顺行股骨髓内钉固定术后发生异位骨化的风险。
