Ilizarov Technique for Treating Elbow Stiffness Caused by Myositis Ossificans: A Case Report

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2024 Jun 20

PMID 38898861

Authors

Ming-Wang Zhou

Peng-Wei Zhang

An-Le Zhang

Chang-Hao Wei

Yu-De Xu

Wei Chen

Zhi-Bin Fu

Affiliations

Soon will be listed here.

Abstract

Background: Myositis ossificans (MO) is a rare disease involving the formation of bone outside the musculoskeletal system. While surgical intervention is the main treatment approach, preventing recurrence and standardized rehabilitation are also crucial. Here, we present a surgical strategy to prevent the recurrence of MO.

Case Summary: A 28-year-old female patient was admitted for the first time for a comminuted fracture of the left olecranon. However, incorrect postoperative rehabilitation resulted in the development of elbow joint stiffness with ectopic ossification, causing a loss of normal range of motion. The patient was diagnosed with MO based on physical examination, X-ray findings, and clinical presentation. We devised a surgical strategy to remove MO, followed by fixation with an Ilizarov frame, and implemented a scientifically reasonable rehabilitation plan. The surgery lasted for 3 h with an estimated blood loss of 45 mL. A drainage tube was placed after surgery, and fluid was aspirated through ultrasound-guided puncture. The patient experienced a significant reduction in joint stiffness after surgery. In the final follow-up at 9 mouths, there was evident improvement in the range of motion of the elbow joint, and no other symptoms were reported.

Conclusion: The Ilizarov frame is an advantageous surgical technique for facilitating rehabilitation after MO removal. It offers benefits such as passive recovery, individualized treatment, and prompt recovery.

References

Kokkosis A, Balsam D, Lee T, Schreiber Z . Pediatric nontraumatic myositis ossificans of the neck. Pediatr Radiol. 2009; 39(4):409-12. DOI: 10.1007/s00247-009-1165-1. View

Spiegelberg B, Parratt T, Dheerendra S, Khan W, Jennings R, Marsh D . Ilizarov principles of deformity correction. Ann R Coll Surg Engl. 2010; 92(2):101-5. PMC: 3025247. DOI: 10.1308/003588410X12518836439326. View

Ji T, Zhang G, Zhang J, Li Y, Zhang X, Liu Q . Myositis Ossificans of the Trapezius Muscle: A Case Report and Literature Review. Ear Nose Throat J. 2023; 103(9):NP520-NP526. DOI: 10.1177/01455613231175316. View

Ravazzolo R, Cappato S, Bocciardi R . Hints on transcriptional control of essential players in heterotopic ossification of Fibrodysplasia Ossificans Progressiva. Bone. 2017; 109:187-191. DOI: 10.1016/j.bone.2017.10.028. View

Barruet E, Morales B, Cain C, Ton A, Wentworth K, Chan T . NF-κB/MAPK activation underlies ACVR1-mediated inflammation in human heterotopic ossification. JCI Insight. 2018; 3(22). PMC: 6302947. DOI: 10.1172/jci.insight.122958. View

Boquan Q, Yi R, Tingjiang G, Xi L, Hui Z . Complex foot deformities associated with lower limb deformities: a new therapeutic strategy for simultaneous correction using Ilizarov procedure together with osteotomy and soft tissue release. J Orthop Surg Res. 2020; 15(1):492. PMC: 7585178. DOI: 10.1186/s13018-020-02021-w. View

Simmonds J, Taki N, Chilton I, Vecchiotti M . A rare case of pediatric Nontraumatic Myositis Ossificans in the posterior triangle. Int J Pediatr Otorhinolaryngol. 2016; 84:116-8. DOI: 10.1016/j.ijporl.2016.03.003. View

Galeano A, Fraison J, Viala P, Le Blay P, Jorgensen C, Pers Y . Acute inflammatory myalgia: think of myositis ossificans circumscripta. J Rheumatol. 2013; 40(9):1614-5. DOI: 10.3899/jrheum.130040. View

Godoy I, Rodrigues T, Skaf A . Myositis ossificans following COVID-19 vaccination. QJM. 2021; 114(9):659-660. PMC: 8344502. DOI: 10.1093/qjmed/hcab161. View

10.

Kou S, Kile S, Kambampati S, Brady E, Wallace H, De Sousa C . Social and clinical impact of COVID-19 on patients with fibrodysplasia ossificans progressiva. Orphanet J Rare Dis. 2022; 17(1):107. PMC: 8894823. DOI: 10.1186/s13023-022-02246-4. View

11.

de Ruiter R, Wisse L, Schoenmaker T, Yaqub M, Sanchez-Duffhues G, Eekhoff E . TGF-Beta Induces Activin A Production in Dermal Fibroblasts Derived from Patients with Fibrodysplasia Ossificans Progressiva. Int J Mol Sci. 2023; 24(3). PMC: 9916423. DOI: 10.3390/ijms24032299. View

12.

Bai Q, Zou X, Yang G, Fan Y, Wang W, Zhang B . Painful and restricted hip due to myositis ossificans circumscripta of the pectineus muscle after pelvic fracture: A case report. Medicine (Baltimore). 2023; 102(17):e33694. PMC: 10145730. DOI: 10.1097/MD.0000000000033694. View

13.

Haviv R, Moshe V, De Benedetti F, Prencipe G, Rabinowicz N, Uziel Y . Is fibrodysplasia ossificans progressiva an interleukin-1 driven auto-inflammatory syndrome?. Pediatr Rheumatol Online J. 2019; 17(1):84. PMC: 6925442. DOI: 10.1186/s12969-019-0386-6. View

14.

Balboni T, Gobezie R, Mamon H . Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis. Int J Radiat Oncol Biol Phys. 2006; 65(5):1289-99. DOI: 10.1016/j.ijrobp.2006.03.053. View

15.

Smilde B, Botman E, de Ruiter R, Smit J, Teunissen B, Lubbers W . Monitoring and Management of Fibrodysplasia Ossificans Progressiva: Current Perspectives. Orthop Res Rev. 2022; 14:113-120. PMC: 9035442. DOI: 10.2147/ORR.S337491. View

16.

Cole P, Dugarte A, Talbot M, Routt Jr M . Early resection of ectopic bone in patients with heterotopic ossification about the hip after trauma. Injury. 2020; 51(3):705-710. DOI: 10.1016/j.injury.2020.01.021. View

17.

Lawand J, Loeffelholz Z, Khurshid B, Barcak E . Heterotopic Ossification after Trauma. Orthop Clin North Am. 2022; 54(1):37-46. DOI: 10.1016/j.ocl.2022.08.007. View

18.

Nieman D, Wentz L . The compelling link between physical activity and the body's defense system. J Sport Health Sci. 2019; 8(3):201-217. PMC: 6523821. DOI: 10.1016/j.jshs.2018.09.009. View

19.

Brance M, Coccaro N, Casalongue A, Duran A, Brun L . Extensive progressive heterotopic ossification post-Covid-19 in a man. Bone. 2021; 155:116287. PMC: 8653400. DOI: 10.1016/j.bone.2021.116287. View

20.

Peake J, Neubauer O, Walsh N, Simpson R . Recovery of the immune system after exercise. J Appl Physiol (1985). 2016; 122(5):1077-1087. DOI: 10.1152/japplphysiol.00622.2016. View