Service de Chirurgie Orthopédique, Traumatologie et Chirurgie Réparatrice des Membres, Hôpital d’Instruction des Armées Percy, France
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Traumatic neurological lesions may lead to development of heterotopic ossification. These cases are classified as ‘neurogenic heterotopic ossifications’ (NHOs). The associated neurological lesions can be caused by cranial trauma or spinal cord injury and may sometimes include a local trauma.
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NHOs that form around the hip joints are of particular interest because they often cause the patient to avoid the sitting position or the resumption of walking.
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Whilst NHO can involve the knee, shoulder and elbow joints, hip-involving NHOs are more numerous, and sometimes develop in close contact with vascular or neurological structures.
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Multi-disciplinary clinical examination is fundamental to evaluate patients for surgical intervention and to define the objectives of the surgery. The best investigation to define an NHO mass is a computerized tomography (CT) scan.
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Resection is performed to liberate a fused joint to provide functionality, and this need not be exhaustive if it is not necessary to increase the range of motion.
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While recurrence does occur post-surgery, a partial resection does not pose a greater risk of recurrence and there are no adjuvant treatments available to reduce this risk.
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The greatest risks associated with NHO surgical resection are infection and haematoma; these risks are very high and must be considered when evaluating patients for surgery.
Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180098
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, a pathologist, an oncologist, a vascular surgeon, and a plastic surgeon. Nowadays, benign tumours around the elbow such as juxta-articular osteoid osteoma (ΟΟ) can be treated with minimally invasive techniques such as CT-guided percutaneous
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-inflammatory drugs (NSAIDs) can be an indication for the presence of an osteoid osteoma ( 13 , 14 ). Due to the absence of pain, fractures or other symptoms and the low prevalence of some tumours in the foot and ankle, diagnosis is frequently delayed ( 3 , 4 , 15
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examination must be carried out including observation of the child’s gait, skin changes, and deformities. Scoliosis or kyphosis frequently develop in children with spine tumours in response to pain, very typical in osteoid osteoma and osteoblastoma, or
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lesion may not normally elicit a response from the bone or periosteum. Some lesions, such as osteoid osteoma, may cause a solid thickening of the bone around them. Tumours which are rapidly increasing in size give the most impressive and characteristic
These authors contributed equally to this manuscript
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These authors contributed equally to this manuscript
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These authors contributed equally to this manuscript
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and cartilage. 1 – 4 Osseous surface bone tumours include benign tumours such as osteoma, osteoid osteoma and osteoblastoma, and the malignant category of surface osteosarcomas (parosteal, periosteal and high-grade osteosarcoma), while the
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, such as non-ossifying fibroma, fibrous dysplasia and osteoma, do not require a biopsy and biopsy of such lesions may even be misleading and distracting for the pathologist. As part of this hypothesis, the following questions should be discussed
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fatigue fractures, osteoarthritis or benign lesions such as osteoid osteoma. In soft-tissue tumours, it can help to assess secondary bone involvement in aggressive lesions. 15 Diagnosis: the biopsy When? A biopsy is always necessary in the
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, osteoid osteoma. Resection of distal fibula and soft tissue reconstruction A summary of patients treated with resection of the distal fibula and soft tissue reconstruction is presented in Table 2 ( 6 , 7 , 12 , 30 , 31 , 32 , 33
