Short-term outcome after resection of neurogenic heterotopic ossification around the hips and elbow following encephalitis.

Heterotopic ossification (HO) is a potential complication following brain or spinal cord injuries and diseases. Post-encephalitis HO is rare, and the number of affected joints is a prognostic predictor. A literature review revealed only a limited number of such cases, with one or two anatomical regions affected in each case. We report the case of a 21-year-old man who developed HO at the peri-articular regions of both hips and the right elbow post encephalitis. He had good functional outcome following excision of the ossific masses. There has not been any recurrence for up to two years from the first surgery. To the best of our knowledge, this is the first such case involving more than two anatomical regions, and the first reported case from Sri Lanka.

An unusual case of adult onset progressive heterotopic ossification suggesting a variant form of fibrodysplasia ossificans progressiva.

Progressive heterotopic ossification (HO) is a rare disease of genetic inheritance. Fibrodysplasia ossificans progressiva (FOP) is an identified debilitating subcategory in which anomalous ossification usually begins in childhood. Congenital big toe anomalies and specific patterns of progression of ossification confirm the classic disease. Adult onset disease is extremely rare. The mechanism of disease progression is still unclear, and there is no consensus on the treatment modalities. We report a 47-year-old man with adult-onset progressive HO around the bilateral pelvic and shoulder girdles and thoracolumbar spine, which suggested a variant form of FOP. Although surgical excision is considered counterproductive in FOP, our patient showed improvement in his shoulder movement following surgery. Other management strategies, including surgery around the hips, indomethacin prophylaxis, irradiation and bisphosphonate therapy, did not improve his range of movement or disease progression.