A man with hip pain post-trauma

A 22-year-old man presented to the emergency department with new left hip pain and chronic firmness after a fall. He has a history of multiple traumatic injuries and quadriplegia secondary to a motor vehicle accident 8 months prior. Examination reveals a firm, irregularly shaped left thigh with mild tenderness to the hip and thigh.

X-ray of the left hip shows extensive bulky heterotopic ossifications, and a computed tomography scan shows myositis ossificans about the left iliopsoas bursa (Figures 1 and 2). Prior to discharge, the patient was counseled on the importance of continuing physical therapy, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for symptomatic management, and the importance for a follow-up outpatient x-ray.

Heterotopic ossificans refers to bone deposition within soft tissue, with myositis ossificans specifically referring to muscle. This can occur in up to half of spinal cord injury patients, most commonly 12 weeks after injury.¹ Plain radiographs are of low utility early on, as calcification may take months to appear. Early ultrasound² or triple phase bone scan has high reliability as a diagnostic method. Treatment modalities include range of motion exercises to support joint mobility and NSAIDs. More recently, bisphosphonates have shown utility in halted progression of ossification.³ Surgery remains an option for refractory cases, but recurrence is common.