Bridging glenohumeral heterotopic ossification at the Kenyatta national hospital : a case report

Abstract

Heterotopic Ossification (HO) is defined as the process by which trabecular bone forms outside of the skeletal structure, occupying space in soft tissues where it does not normally exist. Three forms have been identified. There are traumatic, neurologic and the rare genetic forms of heterotopic ossification. It is a severe complication when it occurs. It can manifest with reduced range of joint movements, pain, stiffness and even compromised hygiene. It can also mimic malignant bone sarcomas. It is considered a very rare lesion in the shoulder. Management begins with prophylaxis in the individuals at risk by pharmacological means and/or irradiation. Surgery is reserved for those situations where the bone has matured and the benefits far outweigh the risks. Recurrence after surgery is a very common event. Prophylaxis after surgery for heterotopic ossification is highly recommended.
This case report is of a bridging posttraumatic glenohumeral heterotopic ossification of the left shoulder with a concommitant posterior axillary fold contracture which was treated by closed serial manipulations followed by contracture release, transpositional flap fashioning and split thickness skin grafting, showing good early postoperative functional results. There is no clear report to date of serial closed manipulation, transpositional flap fashioning and split thickness skin grafting in the literature on the management of heterotopic ossification of the shoulder.