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Fibrodysplasia ossificans in a German shepherd dog.

Bilateral cervical heterotopic ossification, associated with a thoracic limb lameness, occurred in an adult German shepherd dog. One of the lesions, thought to be the cause of the lameness, was surgically removed and the lameness resolved. The lesion was classified morphologically as fibrodysplasia ossificans. A similar, smaller lesion was present over the cranial distal scapular border. The causes of ectopic ossification, as described in the veterinary literature, are reviewed and compared with myositis ossificans in humans. Non-progressive fibrodysplasia ossificans has been described in cats, but this appears to be the first report in the dog. It is postulated that the heterotopic ossification resulted from the metaplastic change of calcinosis circumscripta lesions.

Animals↗

Delayed open reduction for supracondylar fractures of the humerus.

Twenty children with grade IV supracondylar fractures of the humerus had an open reduction 11 to 17 days after injury. The delay was due to swelling and blisters. Most patients recovered a useful range of movement and there were no complications. A posterior approach with V-Y plasty of the triceps makes it easy to align the fragments and reduces the incidence of cubitus varus. Apprehension about the risk of increasing the extent of myositis ossificans is unfounded.

Child↗

Fibrodysplasia ossificans circumscripta of the masseter muscle.

Fibrodysplasia ossificans circumscripta (FOC) is a lesion characterized by localized calcification of the investing fascia of skeletal muscle. It is often related to repeated trauma and was formerly known as traumatic myositis ossificans. Surgical procedures involving muscles are also believed to be a factor in the origin of the lesion. When FOC develops in the muscles of mastication it can lead to severe trismus. A case is reported of FOC in the left masseter muscle of a 44-year-old man who presented with marked limitation of opening. It was believed that previous fractures of the left maxilla and mandible and/or the subsequent surgical treatments were responsible for the onset of FOC. The radiographic and microscopic features of FOC are discussed in relation to recent theories on the etiology, pathogenesis, and treatment of the lesion.

Adult↗

[The radiogical criteria of juvenile rheumatic cerivical synostosis in adults (author's transl)].

The radiological criteria of juvenile, rheumatic, cervical synostosis discovered in adult life are described and illustrated. These include: involvement of few or many segments, a tendency to bony ankylosis of the diseased intervertebral joints, dysplasias or hypoplasia of the vertebral body and intervertebral disc and dysplasias of the neural arches and hypoplasia of the transverse processes. Pathological ossification may involve the ligamentum flavum, the annulus, or the entire disc. The differential diagnosis of juvenile, rheumatic, cervical synostosis includes congenital block vertebrae, Klippel-Feil syndrome, acquired block vertebrae, juvenile ankylosing spondylitis, synostosing, intervertebral osteochondrosis and myositis ossificans progressiva.

Adolescent↗

Total hip replacement in patients with ankylosing spondylitis with involvement of the hip.

Twenty-three patients with ankylosing spondylitis underwent thirty-four total hip arthroplasties with an average follow-up of 42.5 months. The over-all results were rated good in all but two patients. Significant benefit was obtained in posture and function so that these patients could be gainfully employed. Improvement in the sum total range of motion was 96.1 degrees in patients with bone ankylosis and 150 degrees in those with fibrous ankylosis. The preoperative sum total range of motion was maintained or improved in hips with a painful arc of motion. Most of the limited motion in patients with ankylosed hips was due to myositis ossificans.

Adult↗

[Diagnosis and differential diagnosis of osteosarcoma (author's transl)].

A primary malignant bone disease can generally be suspected on the basis of x-ray findings and may be even highly probable if several signs of malignancy are seen on one and the same film. Such changes include bone lesions larger than 6 cm on the first film with blurred outlines, showing patterns of destruction resembling moth-eaten textiles, the covering periosteum revealing spicula or Codman's triangles. Rapidly growing tumours can break cortex components from the continuous layer and shift them outwards. Roentgenological case controls are useless and must be replaced by a sample excision, since x-ray malignancy signs have no absolute value as decisive criteria in view of the fact that they are seen, inter alia, also in osteomyelitis, myositis ossificans and callus formations.

Bone Neoplasms↗

Total hip arthroplasty in ankylosing spondylitis.

Total hip arthroplasty was performed on 29 hips in 19 patients diagnosed with ankylosing spondylitis over a 13-year period. The results were analyzed retrospectively with an average follow-up period of more than four years. Complete pain relief was achieved in 97%, and significant gains were made in ambulatory capacity. The limited gains in total range of motion (average improvement 75 degrees) were felt to be primarily due to the high incidence of Brooker Class III and IV myositis ossificans (23%) and long-standing soft tissue contractures.

Adult↗

[Pitfalls in MRI diagnosis of primary malignant bone tumors].

MRI has gained an undisputed place in the evaluation of malignant bone tumors, not only for verifying results of conventional radiographs and clarifying differential diagnoses; it has also become increasingly important for the assessment of the malignant/benign nature of the tumor, its growth rate, definition of adequate sites for biopsy, local preoperative staging, and evaluation of the response to chemotherapy. However, several pitfalls have to be observed regarding choice of technical parameters (coils, sequences, imaging planes), tissue differentiation, and tumor staging. When staging malignant tumors, critical aspects which have to be observed are tumor extension, integrity of the cortical bone, soft tissue components, infiltration of a joint or neurovascular bundle. The use of contrast agents provides important additional information but can also give rise to misinterpretations. Thus, all features of a tumor have to be observed in order to establish a final diagnosis. Particular difficulties can occur with the interpretation of MR images of osteomyelitis, osteoid osteoma, stress and insufficiency fractures, bone infarcts, myositis ossificans, hemangiomas, and aneurysmal bone cysts.

Bone Cysts↗

Skeletal muscle injuries.

Muscular injuries are extremely common in athletes. Treatment of these injuries is based on a solid understanding of anatomy, physiology, and healing of skeletal muscle. Injuries discussed include contusions, hematomas, myositis ossificans, delayed onset soreness, strain, rhabdomyolysis, and lacerations. Diagnosis and treatment of these injuries is essential for the sports medicine physician.

Contusions↗

Bone block transfer of coracoacromial ligament in acromioclavicular injury.

A bone block transfer of coracoacromial ligament into the medullary canal of the clavicle for Grade III acromioclavicular injury was developed in an attempt to prevent occasional pullout of the ligament in the procedure described by Weaver and Dunn. Fifteen consecutive cases (12 acute, three chronic) with Grade III acromioclavicular injury were treated by this method. All but one patient regained painless full range of shoulder motion. All patients returned to previous activity. Failure of coracoclavicular reconstruction occurred in one case. Asymptomatic focal myositis ossificans developed in four cases with no functional deficit.

Acromioclavicular Joint↗

[Disseminated branching pulmonary ossification combined with heterotopic bone formation in the muscles (author's transl)].

Idiopathic disseminated pulmonary ossification is a rarely recognised condition in which small pieces of marrow containing bone are found in the interstitial tissues of the lungs. The case reported here is unique in showing combination with myositis ossificans circumscripta. The extent of the lung changes was also unusual. The clinical, radiological and histological findings are compared.

Diagnosis, Differential↗

Pneumococcal psoas abscess.

Primary extrapulmonary pneumococcal disease has become a rarity in modern times. We describe a 40-year-old patient who developed an abscess of the psoas muscle as the only evidence of pneumococcal disease. A predisposing local condition was prior trauma of the psoas muscle, documented by the existence of myositis ossificans circumscripta. This case emphasizes the importance of considering unusual sites of involvement of pneumococcal disease.

Abscess↗

Muscle contusion injuries: current treatment options.

Muscle contusion is second only to strain as the leading cause of morbidity from sports-related injuries. Severity depends on the site of impact, the activation status of the muscles involved, the age of the patient, and the presence of fatigue. The diagnosis has traditionally been one of clinical judgment; however, newer modalities, including ultrasonography, magnetic resonance imaging, and spectroscopy, are becoming increasingly important in both identifying and delineating the extent of injury. Although controlled clinical studies are scarce, animal research into muscle contusions has allowed the description of the natural healing process, which involves a complex balance between muscle repair, regeneration, and scar-tissue formation. Studies are being performed to evaluate the effects of anti-inflammatory medications, corticosteroids, operative repair, and exercise protocols. Prevention and treatment of complications such as myositis ossificans have also been stressed, but recognition may improve the outcome of these ubiquitous injuries.

Animals↗

Non-neoplastic conditions presenting as soft-tissue tumours.

Review of referrals to our unit over the last 7 years showed that of approximately 750 cases referred as soft-tissue tumours, 132 were subsequently diagnosed as non-neoplastic lesions. The imaging characteristics of these lesions are presented to differentiate them from neoplasms. The most common diagnoses were myositis ossificans, ganglion cyst, abscess/infection, bursitis and synovitis. The imaging features of other rarer conditions will also be discussed.

Abscess↗

Heterotropic bone formation as a complication of elective joint replacement in haemophilic patients - a case report and literature review.

We report two cases of this rare postoperative condition. Both patients having undergone extensive surgery to their hips, developed increased bone growth in the soft tissue of the hip, accounting for the reduced range of movement, pain and stiffness. Plain x-rays taken confirmed the presence of heterotopic ossification, also known as a variant of myositis ossificans. We review the literature and discuss treatment options of this rare condition in patients with end-stage haemophilic arthropathy.

Aged↗

Acquired syngnathia.

We report two cases of acquired syngnathia, in case 1 probably as a result of a fibrotic tubed pedicle and in case 2 from myositis ossificans. The treatment plan for syngnathia must include not only operation but also a rehabilitation programme (particularly muscle training)

Child, Preschool↗

Pathogenesis of some traumatic and degenerative disorders of soft tissue.

1. Trauma to soft tissues is associated with tissue rupture and formation of a haematoma. 2. Such lesions cannot be expected to resolve without complications in the absence of appropriate treatment. 3. Myositis ossificans should be anticipated in lesions of muscles adjacent to their attachments. 4. Chronic tendonitis and enthesopathies not associated with inflammatory connective tissue disease are primarily degenerative in nature and are probably the result of comparative ischaemia. Mesenchymoid transformation is a feature of both.

Contusions↗

[Progressive fibrodysplasia assificans].

A five years old patient with myositis ossificans progressiva is presented. This very rare disease is inherited as an autosomal dominant and it is characterized by an abnormality of the connective tissue, specifically, aponeurosis, fascias, tendons and ligaments; the muscle are secondarly affected.

Child, Preschool↗