Eur J Pediatr Surg 2010; 20(5): 351-353
DOI: 10.1055/s-0030-1249633
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Heterotopic Para-Articular Ossification in a Child Following Flame Burns

C. E. Price1 , M. Guggenheim2 , H. Rode3
  • 1UCT, General Surgery, Cape Town, South Africa
  • 2University Hospital Zürich, Department of Plastic and Reconstructive Surgery, Zürich, Switzerland
  • 3Red Cross War Memorial Children's Hospital, Paediatric Surgery, South Africa, South Africa
Further Information

Publication History

Publication Date:
09 April 2010 (online)

Introduction

Heterotopic bone formation, ormyositis ossificans circumscripta in Latin, is a rare, but well-known complication of severe burns[1]. Its occurrence following burns was first described in the English literature by Johnson[2]. Pain, tenderness, joint stiffness and even permanent disability may result if this pathological ossification occurs around joints[4].

The most common sites of heterotopic bone formation are the major joints and large muscle groups[4] [5]. The elbow is the most frequently involved joint in most burn case series[4].

It is necessary to consider the presence of heterotopic para-articular ossification around the elbow in any burns patient who complains of limitation of elbow movement or pain. This should be suspected even if there is no burn around the elbow, since the calcification may be as a result of metastatic calcification[2]. Unless a radiograph is taken routinely, ossification may not be recognised.

References

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  • 2 Evans EB, Smith JR. Bone and joint changes following burns.  Journal of Bone and Joint Surgery. 1959;  41 A 785-799
  • 3 Kumar V, Abbas AK, Fausto N. Cellular adaptations, cell injury, and cell death.. In: Robbins, and, Cotran Pathological Basis of Disease. 7th . ed. Philadelphia: Elsevier Saunders; 2005: 3-46
  • 4 Evans EB. Orthopaedic measures in the treatment of severe burns.  Journal of Bone and Joint Surgery. 1966;  48A 643-669
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  • 8 Engber W, Reyen P. Post-burn heterotopic ossification at the elbow.  Iowa Orthopaedic Journal. 1994;  14 38-41
  • 9 Kolar J, Vrobec R. Periarticular soft-tissue changes as a late consequence of burns.  Journal of Bone and Joint Surgery. 1959;  41A 103-111
  • 10 Elledge ES, Smith AA, Mc Manus WF. et al . Heterotopic bone formation in burned patients.  Journal of Trauma. 1998;  28 684-697
  • 11 Dias DA. Hetertotopic ossification of the elbow with soft tissue contracture in burns.  Burns. 1981;  9 128-134
  • 12 Ellis M, Frank HG. Myositis ossificans traumatica with special reference to the quadriceps femoris muscle.  Journal of Trauma. 1976;  6 724-738
  • 13 Crawford CM, Varghese G, Mani MM. et al . Heterotopic ossification: are range of motion exercises contraindicated?.  Journal of Burn Care and Rehabilitation. 1986;  7 323-327
  • 14 Klein MB. Thermal, Chemical and Electrical Injuries.. In: Aston SJ, Bartlett SP, Gurtner G, Spear SL, Beasley RW (eds). Grabb and Smith's Plastic Surgery. 6th ed. Philadelphia: Lippincot Williams & Wilkins; 2007: 132-149

Correspondence

Dr. Christopher Edward PriceBSc, MB, ChB 

UCT, General Surgery

Old Main Building

7701 Cape Town

South Africa

Phone: +27/82/375 1413

Fax: +27/21/686 2000

Email: cprice2009@cybersmart.co.za

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