Heterotopic ossification in critical illness and cancer: a report of 2 cases

Heterotopic ossification is the abnormal development of bone tissue within periarticular soft tissue. We present 2 Turkish patients with malignant thoracic cancer who underwent extensive thoracic surgery and required prolonged postoperative chemical paralysis and cardiorespiratory support for respiratory complications. Both patients were found by the physiatrist to have multiple, extensive heterotopic ossifications. Clinical findings in both patients included joint swelling and severe limitation in range of motion (ROM) associated with pain. The diagnoses were confirmed radiographically. After an extended length of inpatient rehabilitation, both patients improved their cumulative FIM instrument motor scores by 23 and were discharged with a trained family member. Our findings suggested that heterotopic ossification should be suspected in patients presenting with decreased ROM, increased pain, and joint swelling after prolonged immobilization. Serum alkaline phosphatase might be used as an effective screening tool.