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23-year-old male patient with history of severe traumatic brain injury presents to inpatient rehabilitation with left hip pain and decreased range of motion

Meriggi, Jenna, D.O.; Weppner, Justin, D.O.

American Journal of Physical Medicine & Rehabilitation: March 27, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/PHM.0000000000001186
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23-year-old male admitted to inpatient rehabilitation unit following a severe traumatic brain injury secondary to motor vehicle accident. The patient’s 71-day acute hospital course was complicated by prolonged coma, respiratory failure requiring tracheostomy placement, pneumonia, sepsis, dysphagia with percutaneous endoscopic gastrostomy placement, spastic left hemiplegia, and bilateral lower extremity deep vein thromboses. Passive range-of-motion of the left hip was limited and painful. Heterotopic ossification was clinically suspected, and an x-ray of the pelvis revealed left hip joint space narrowing with heterotopic ossification present medially and laterally about the hip joint. Heterotopic ossification is the formation of mature, lamellar bone in extra-skeletal soft tissue where bone does not usually exist. It is thought to be associated with local inflammation and the differentiation of mesenchymal stem cells present in soft tissues into osteoprogenitor cells. Plain radiographs are specific for heterotopic ossification but not sensitive in early formation. When positive, radiographs show circumferential bone formation near a joint. Prophylactic treatment includes ROM exercises, non-steroidal anti-inflammatory medications, and bisphosphonates. Current treatment recommendations include joint mobilization with ROM exercises and surgical resection. If the patient continues to have impaired function with deficits in mobility, transfers, hygiene, or activities of daily living despite non-surgical management, surgical resection should be considered.

University of Pittsburgh Medical Center

University of Pittsburgh Medical Center

Corresponding Author: Justin Weppner, 3471 Fifth Ave, Pittsburgh, PA 15213, Phone: (703) 298-5391,

The authors of this manuscript, Jenna Meriggi and Justin Weppner, have nothing to disclose. No funding was received for this study.

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