Re: Heterotopic Ossification
CPO 1
Description
Collection
Title:
Re: Heterotopic Ossification
Creator:
CPO 1
Text:
This is an interesting discussion, for me. I currently have a Symes patient
who has heterotopic ossification that protrudes straight downward (in sort-of
a bell curve shape) about 6 mm in the center of the distal end of the tibia.
It appears that the heterotopic protrusion covers about 20 percent of the end
of the distal tibia. This patient was amputated about 25 years ago, is quite
tall and weighs 300+ pounds. He cannot bear weight distally for any period of
time. As I understand it (new patient to me) this has always been the case.
I had him get a series of x-rays back in November, or so, which revealed the
heterotopic dilemna. His medial and lateral malleolus appear to have been
shaved. His distal limb circumference is 9 inches and the neck of the distal
tibial meaures 7 1/2 inches. To date, I have had difficulty getting him pain-
free. But his chief complaint has been one of an isolated pinching sensation
in the distal-medial-neck area, just proximal to the bulbous area, of his
limb. This problem occurs when he lifts the prosthesis off the ground.
I had hoped to use an Alpha liner, along with a TEC distal pad, but this only
worked for a short period of time. I suspect that he blows past the jelly --
shear-force-wise-- and eventually ends up on the end of his tibia. Anyway, I
am back to a compression-fit Kemblo & leather liner and working like a slave
to get weight appropriately captured proximally. There are no doors or
donning slits, only Kemblo buildups. In addition to heterotopic bone, I
believe circulation is being compromised distally, as compared to his past.
There is an isolated medial-distal area that is somewhat jaundiced. He
probably needs a standard trans-tibial revision, but, unfortunately, I cannot
be the one to suggest such treatment. During fittings,
Finally my questions. Anyone had a similar Symes problem? Vascular? What,
if anything, can be done to lessen the effect of heterotopic ossification? Is
it possible to use an isolated chemical nerve block? Should pressure be
applied to adjacent areas of the heterotopic ossification, or would that
likely increase the magnitude of the protrusion? Thoughts and suggestions
will be appreciated.
Wil Haines, CPO
who has heterotopic ossification that protrudes straight downward (in sort-of
a bell curve shape) about 6 mm in the center of the distal end of the tibia.
It appears that the heterotopic protrusion covers about 20 percent of the end
of the distal tibia. This patient was amputated about 25 years ago, is quite
tall and weighs 300+ pounds. He cannot bear weight distally for any period of
time. As I understand it (new patient to me) this has always been the case.
I had him get a series of x-rays back in November, or so, which revealed the
heterotopic dilemna. His medial and lateral malleolus appear to have been
shaved. His distal limb circumference is 9 inches and the neck of the distal
tibial meaures 7 1/2 inches. To date, I have had difficulty getting him pain-
free. But his chief complaint has been one of an isolated pinching sensation
in the distal-medial-neck area, just proximal to the bulbous area, of his
limb. This problem occurs when he lifts the prosthesis off the ground.
I had hoped to use an Alpha liner, along with a TEC distal pad, but this only
worked for a short period of time. I suspect that he blows past the jelly --
shear-force-wise-- and eventually ends up on the end of his tibia. Anyway, I
am back to a compression-fit Kemblo & leather liner and working like a slave
to get weight appropriately captured proximally. There are no doors or
donning slits, only Kemblo buildups. In addition to heterotopic bone, I
believe circulation is being compromised distally, as compared to his past.
There is an isolated medial-distal area that is somewhat jaundiced. He
probably needs a standard trans-tibial revision, but, unfortunately, I cannot
be the one to suggest such treatment. During fittings,
Finally my questions. Anyone had a similar Symes problem? Vascular? What,
if anything, can be done to lessen the effect of heterotopic ossification? Is
it possible to use an isolated chemical nerve block? Should pressure be
applied to adjacent areas of the heterotopic ossification, or would that
likely increase the magnitude of the protrusion? Thoughts and suggestions
will be appreciated.
Wil Haines, CPO
Citation
CPO 1, “Re: Heterotopic Ossification,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 16, 2024, https://library.drfop.org/items/show/210453.
