Heterotopic periarticular ossification in burns

The pathogenesis of this rather rare complication of burn injury is discussed. Injury and bleeding as a result of enthusiastic physiotherapy are usually incriminated as the major cause of such bone formation. More recent work is quoted which suggests that increased nutritional support regimes, particularly in respect of protein, cause a calciuretic response in burn patients. This iatrogenic mobilization of calcium, together with the increased levels of calcium due to injury and bed rest, may precipitate this complication. The periarticular location usually seen in burns, as compared with the heterotopic sites in muscle following other forms of injury, is noted. Although spontaneous resolution can sometimes occur, an active approach, with surgical excision being early rather than deferred, is advocated.