title: Refractory heterotopic ossification with complications.
abstract: BACKGROUND
  Heterotopic ossification (HO) following spinal cord injury can lead to various complications, including venous thrombosis, autonomic dysreflexia, and pressure ulcers. We report refractory, complicated HO in a 19-year-old man with C8 incomplete tetraplegia. He first presented at 9 weeks postinjury with fever and swelling of his right leg. Ultrasound indicated a deep venous thrombosis (DVT). Persistent symptoms prompted triple-phase bone scan and magnetic resonance imaging (MRI), which revealed HO compressing the right external iliac vein and no evidence of DVT. The HO was complicated by hypercoagulability.
  
  
  METHODS
  The HO was refractory to oral indomethacin and etidronate; therefore, intravenous etidronate was instituted, resulting in only a transient decrease in alkaline phosphatase. Local irradiation of the right hip did not decrease the activity of HO. The patient was discharged on oral etidronate, indomethacin, and warfarin. This complicated case raises issues regarding early diagnosis and aggressive treatment of HO, as well as treatment of associated hypercoagulability.
authors.affiliation: Department of Rehabilitation Medicine, VA Puget Sound Health Care System/University of Washington Medical Center, Seattle 98108, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Yin
authors.forename: J
authors.initials: J
authors.lastname: James
authors.forename: K
authors.initials: K
authors.lastname: Lew
authors.forename: J W
authors.initials: JW
authors.lastname: Little
mesh_terms: D003251:Constriction, Pathologic / Q000175:diagnosis; D003952:Diagnostic Imaging; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein; D008297:Male; D009999:Ossification, Heterotopic / Q000150:complications* / Q000175:diagnosis; D011782:Quadriplegia / Q000150:complications / Q000175:diagnosis; D013119:Spinal Cord Injuries / Q000150:complications* / Q000175:diagnosis; D020246:Venous Thrombosis / Q000175:diagnosis / Q000209:etiology*