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Published on: August 6, 2015
Pediatric Heterotopic Ossification: A Comprehensive Review
Alexander R Markes1, Nikit Venishetty2, Andrew Gatto3
1Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, USA. Alexander.Markes@ucsf.edu.
Insights
Heterotopic ossification (HO) is rare in children, often following severe neurologic injury. Further pediatric research is needed for effective management strategies and guidelines.
Area of Science:
- Pediatric Orthopedics
- Regenerative Medicine
- Medical Research
Background:
- Heterotopic ossification (HO) involves ectopic bone formation in soft tissues like muscles and tendons.
- HO development is influenced by factors including oxygen tension, pH, micronutrients, and mechanical stimuli.
- The most common theory suggests multipotent cells as the origin of HO.
Purpose of the Study:
- To comprehensively analyze heterotopic ossification (HO) in pediatric patients.
- To examine risk factors, prophylactic measures, and management strategies for pediatric HO.
- To identify gaps in current knowledge and research needs for pediatric HO.
Main Methods:
- Review of existing literature on heterotopic ossification in pediatric populations.
- Analysis of diagnostic methods including physical examination, radiography, and CT scans.
- Evaluation of current prophylactic and surgical management strategies.
Main Results:
- Heterotopic ossification (HO) is rare in children, most commonly caused by severe neurologic injury, followed by trauma and surgery.
- Prophylactic measures like NSAIDs and radiation therapy have limited documented use in pediatric patients.
- Surgical resection is an option for severe cases but carries significant risks and morbidity.
Conclusions:
- There is a critical need for pediatric-specific research to develop evidence-based guidelines for HO management.
- Current prophylactic and treatment strategies require further investigation for efficacy and safety in children.
- Understanding the unique aspects of HO in pediatric patients is essential for improving outcomes.
Purpose Of Review:
The purpose of this review is to provide a comprehensive analysis of heterotopic ossification (HO) in pediatric patients, including an in-depth examination of the risk factors associated with this condition, current prophylactic measures, and available management strategies.
Recent Findings:
HO is a medical disorder in which bone tissue inexplicably develops in soft tissues such as muscles and tendons. It involves the formation of mature, lamellar bone in extra-skeletal soft tissue, and its formation is influenced by oxygen tension, pH, the availability of micronutrients, and mechanical stimulation. HO has many cellular origins, with the most common theory being multipotent cells in local tissue. The diagnosis of HO is typically made based on exam, radiographs, and CT. Management includes both prophylactic nonsurgical options and surgical resection for severe or recalcitrant cases. The review highlights the incidence, risk factors, and management strategies associated with HO in pediatric patients. HO is a rare condition in children, with severe neurologic injury being the most common cause. Pediatric patients most commonly develop HO following severe neurologic injury, followed by trauma and surgery. Current prophylactic measures, include nonsteroidal anti-inflammatory drugs and radiation therapy though limited literature on their use in the pediatric population exists. For recalcitrant symptomatic cases, wide surgical resection can be considered but has a higher risk profile and associated morbidity. This review highlights the need for further pediatric specific research to inform guidelines and management strategies for this debilitating condition.
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