[Peri-articular calcinosis after craniocerebral trauma--the natural course and treatment concepts]

Occurrence of periarticular ossification (PAO) is a serious complication in the rehabilitation of patients with neurological diseases, especially those with severe head injuries. The present concept for operative intervention in PAO postulates late surgical treatment after "maturation" of these heterotopic ossifications, because of a suspected higher rate of reoccurrence after early removal. In a retrospective analysis of nine arthrolysis in six patients with neurological diseases suffering from PAO (five patients with traumatic apallic syndrome and one patient with spontaneous subarachnoidal haemorrhage), the validity of a new concept of treatment of primary neurological diseases was investigated. Because of the well-known secondary and tertiary problems (fibrotic stiffness, osteoporosis, compression syndrome of peripheral nerves, muscle atrophy), we chose early removal of the ossifications. Our results demonstrate that the former concept of surgical intervention in "mature PAO" only can no longer be recommended as superior to early surgical treatment in neurological diseases, particularly in patients with traumatic apallic syndrome associated with PAO.