523 - Regaining Mobility with the use of Radiation Therapy for Heterotopic Ossification in Acute Rehab

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

RI

Rafaello Ibrado, BA

Medical Student
George Washington University School of Medicine and Health Sciences
Arlington, Virginia, United States

Co-Author(s)

FA

Farrah Asaad, DO

Resident Physician
Icahn School of Medicine at The Mount Sinai Hospital
New York, New York, United States
IO

Ian T. O'Connor, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
NEW YORK, New York, United States

Corresponding Author(s)

Miguel X. Escalon, MD/MPH

Associate Professor
Icahn school of medicine at Mount Sinai
New York, New York, United States

Case Diagnosis: Right Femoral Heterotopic Ossification

Case Description: The patient is a 36-year-old male who initially presented after a motorcycle collision with right parietal subdural hematoma, left temporal intra-axial hemorrhage and polytrauma involving fractures of the right proximal and subtrochanteric femur, right distal radius, right ulnar styloid, and right base of first metacarpal. Patient underwent right femoral intramedullary nail, ORIF of right distal radius and ulnar fracture, and percutaneous pinning of right first MCP. Upon admission to inpatient rehabilitation, the patient complained of a persistent right hip pain with an appreciable evolving right hip mass. Right hip x-ray demonstrated surrounding heterotopic ossification (HO) callus with a follow-up triple phase bone scan showing increased radiotracer uptake suggesting active HO. Patient was started on Celecoxib. Radiation oncology then performed radiation mapping with the patient currently undergoing radiation treatment. Patient now reports improved right hip pain without further expansion of the bony mass.

Discussions: Heterotopic ossification is a common condition encountered in many rehab patients following injury which can contribute to pain and disability. Precipitating factors for the development of HO include musculoskeletal trauma such as long bone fracture seen in our patient, burn injuries, or joint replacement surgery. Proper management of HO improves the patient’s quality of life and ability to participate in therapy, thus optimizing functional outcome. Previous studies have described the use of NSAIDs, selective COX-2 inhibitors, and bisphosphonates, in particular etidronate, for HO prophylaxis. However, the use of these therapies with radiation treatment have not been explored after the discovery of HO on radiographic imaging.

Conclusions: Utilizing radiation therapy alongside medication treatment may allow further and more effective management of patient’s HO while in acute rehab. Thus, patients may be able to regain further mobility and function, decreasing the complications associated with HO, such as pain and decreased range of motion.