Global Excision of Severe Heterotopic Ossification of the Shoulder

• DOI: 10.2106/jbjs.cc.18.00080
• Publication Date: 2020-02-19T12:16:56Z
• Authors: Elizabeth M. Polfer; Kyle E. Nappo; Jeffrey R. Giuliani; Leon J. Nesti
• Keywords: Male; Shoulder; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Ossification, Heterotopic; Humans; Olecranon Process; Shoulder Injuries; 3. Good health

Case: A 21-year-old man sustained a closed glenohumeral fracture/dislocation as a pedestrian struck by a motor vehicle. He was treated nonoperatively and developed severe post-traumatic heterotopic ossification (HO) with near-complete shoulder ankylosis. We present our technique for safe surgical excision.

Conclusions: Excision led to improvements in motion and quality of life at 1 year postoperatively. Recommendations for successful HO excision around the shoulder include excision after at least 180 days, appropriate preoperative imaging to include cross-sectional imaging and a 3D model, intraoperative fluoroscopy, well-serviced instruments, preparation for iatrogenic fracture and/or neurovascular injury, meticulous hemostasis, postoperative HO prophylaxis, immediate postoperative therapy, and involvement of a multidisciplinary team.