Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic
myositis ossificans, which develops following traumatic
injuries,
burns or
arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion,
pressure ulcers, nerve compression, swelling,
pain or asymptomatically. Symptomatic patients are most commonly treated with surgical
debridement of the affected heterotopic deposits.Spinal dysraphism (SD) is a term describing a wide range of congenital malformations of the neural tube, ranging from
spina bifida occulta to the more severe form,
myelomeningocele. The cause of SD is multifactorial and has been associated with
chromosomal disorders, teratogenic exposure and
folate deficiency. Many patients with SD experience neuropathy below the affected neurological level, making them particularly susceptible to
pressure ulcers. If these
ulcers are severe and do not respond to
conservative therapy, they often require surgical
debridement and flap reconstruction - a clinical scenario that rarely results in HO.The present article describes a case involving a patient with pelvic HO following
myocutaneous flap reconstruction of a
pressure ulcer. The patient was successfully treated with oral
bisphosphonate and aggressive physiotherapy.