Severe heterotopic bone formation in the knee after tibial intramedullary nailing

The case of a 48-year-old man who developed severe heterotopic bone within and under his patella tendon after closed intramedullary (IM) nailing of his tibia is reported. The patient had a concomitant closed head injury at the time of his tibia fracture. The tibial nailing was done through a patella tendon splitting approach. The patella tendon splitting approach may predispose patients to clinically significant heterotopic bone. Approaches medial or lateral to the tendon are recommended, particularly in patients at risk for heterotopic bone formation.