Increase in cases of postoperative ectopic ossification: a multicenter study
Bulgarian Medical Journal, 2023, 17(3), 44-50.
S. Nikolova1, Y. Pukalski2, P. Georgiev1, R. Kehayov1
1 Department of Orthopedics and Traumatology, Medical University – Sofia
2 UMHATEM “N. I. Pirogov”
Abstract. Objective: To perform a retrospective analysis of postoperative myositis ossificans (MO) in children with open reposition of a luxated coxofemoral joint and adults with surgical treatment of intra-articular fractures of the elbow joint. The study searched for the reasons for an increasing growth in complications in the period January 2020 – January 2023. Material and methods: The study included 16 patients with MO, 5 children with an average age of 9.4 ± 3.57 years and 11 adults with an average age of 46.8 ± 16.25 years. The average time for radiographic manifestation of MO is 133.4 ± 76.97 days in the cases over 18 years and 35.4 ± 13.14 days in children. The assessment for coxofemoral joint was performed by the clinical-radiographic classification of MO of Krum and Miller and the anatomical zone according to Inan and for the elbow joint by the functional classification of Hastings and Graham. Statistical methods adopted for biomedical sciences were used to analyze the data. Results: MO in children is of the most severe IIIC type, 3 cases – of iliopsoas type, and 2 ‒ subtotal capsular. When comparing the studied period with the previous risk ratio, children showed a 58-fold increase in the risk of MO after 2020. In adults, ossification embraces both the capsule and the anterior and posterior muscles with bone blocks between the processus coronoideus, olecranon, the radiocapitellar and humeroulnar joints, and also ossification of the proximal interosseous membrane is seen. Their risk ratio shows that the risk for MO increased 7-fold. Conclusions: The cases of MO in our series increased to 23.8% in children and 25% in adults, which significantly exceeds the usual rate of the complication. There is an increase in severe cases of MO and an earlier radiographic manifestation. The factors discussed as the reasons for it are the protraction of treatment time in all its stages and the change of lifestyle in the country, possibly leading to modification of the immune response and hyperreactivity during the studied period coinciding with the SARS-CoV-2 pandemic.
Key words: ectopic ossification, intra-articular fractures of the elbow joint, luxation of coxofemoral joint, cerebral palsy in children
Address for correspondence: Dr. Sofia Valentinova Nikolova, e-mail: sf_nikolova@yahoo.com