Heterotopic Ossification
Pediatric TBI survivors have about a 14% to 23% chance of developing heterotopic ossification (172). It is more common in children who are over 11 years of age and also more common in children who have two or more extremity fractures (191).
Heterotopic ossification in children with TBI is most common at the hips and knees. Diagnosis is often made approximately one month after injury (191,192). Signs and symptoms of heterotopic ossification include pain, decreased range of motion, and occasionally swelling (192). Deep venous thrombosis may be present concomitantly with heterotopic ossification and warrants further evaluation (193).Treatment of heterotopic ossification begins with regular and aggressive passive range of motion for these patients. Occasionally, splinting is necessary to prevent worsening contracture. Nonsteroidal antiinflammatory drugs such as indomethacin, ibuprofen, or aspirin are often employed in an effort to halt progression once it is identified (191,192). Although in adult rehabilitation patients, heterotopic ossification is often treated with high-dose disodium etidronate, it is avoided in pediatric patients due to concerns for development of rickets or rachitic syndrome (194). Rarely does pediatric heterotopic ossification require surgery (172,191,192).