Willis Alexander R, Samad Adil A, Prado Gail T, Gabisan Glenn G
Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Monmouth Medical Center, Long Branch, NJ.
Orthopaedic Surgery Resident, Department of Orthopaedic Surgery, Monmouth Medical Center, Long Branch, NJ.
J Foot Ankle Surg. 2016 Sep-Oct;55(5):1106-9. doi: 10.1053/j.jfas.2016.01.032. Epub 2016 Apr 12.
Heterotopic ossification has been reported to occur after musculoskeletal trauma (including orthopedic procedures). This has been known to cause nerve entrapment syndromes and persistent pain, limiting joint mobility. We present a case of a 19-year old female collegiate athlete who had previously undergone ankle arthroscopy and arthrotomy to remove 2 ossicles. At approximately 1 year postoperatively, the patient developed pain when planting and pivoting her foot. Imaging revealed a radiodense lesion at the posteromedial ankle consistent with heterotopic ossification and entrapment of the tibial nerve within the tarsal tunnel. The patient underwent surgical resection and postoperative indomethacin prophylaxis. At the 1-year follow-up visit, the patient remained asymptomatic, without evidence of recurrence of the heterotopic ossification. In our review of the published data, we found no previously reported cases of heterotopic ossification causing entrapment of the tibial nerve within the tarsal tunnel. In the present case report, we describe this rare case and the postulated etiologies and pathophysiology of this disease process. In addition, we discuss the clinical signs and symptoms and recommended imaging modalities and treatment.
据报道，异位骨化可发生于肌肉骨骼创伤（包括骨科手术）后。已知其可导致神经卡压综合征和持续性疼痛，限制关节活动度。我们报告一例19岁的女性大学生运动员病例，该患者此前接受了踝关节镜检查和关节切开术以取出2块小骨。术后约1年，患者在足部着地和旋转时出现疼痛。影像学检查显示踝关节后内侧有一高密度病变，符合异位骨化，且胫神经在跗管内受压。患者接受了手术切除，并在术后使用吲哚美辛预防。在1年的随访中，患者无症状，无异位骨化复发迹象。在我们对已发表数据的回顾中，未发现此前有异位骨化导致胫神经在跗管内受压的病例报道。在本病例报告中，我们描述了这一罕见病例以及该疾病过程的推测病因和病理生理学。此外，我们讨论了临床体征和症状、推荐的影像学检查方法及治疗方法。
