Early detection of heterotopic ossification in young patients with traumatic brain injury

Heterotopic ossification (HO) is frequently a complication in patients with severe head injury, impeding the rehabilitation process. Detection of HO is often delayed until the appearance of clinical manifestations. To better characterize the frequency and distribution of HO, a three-year prospective study at a pediatric brain injury rehabilitation unit was done. Triple-phase bone scans were performed routinely on all patients. Early intervention followed, with intensive physical therapy and indomethacin. We report an incidence of HO in 25 of 111 cases (22.5%). Of 55 sites identified, the hip was most commonly affected. Clinically significant heterotopic bone impeded the rehabilitation process in five patients (20%), although none of these patients required surgical intervention. Bone scanning identified HO in patients whose symptoms were clinically silent, as well as in those who were symptomatic. In addition, multiple sites of involvement were found in areas not clinically suspect. This study suggests that HO may be more prevalent in young, traumatically brain injured patients than previously suspected.