title: Heterotopic ossification in the reaming tract of a percutaneous antegrade femoral nail: a case report.
abstract: BACKGROUND
  Heterotopic ossification is a rare complication of musculoskeletal injuries, characterized by bone growth in soft tissues. Percutaneous antegrade intramedullary nailing represents the 'gold standard' for the treatment of femur shaft fractures. Minor bone growth is frequently seen around the proximal end of reamed femoral nails (so-called 'callus caps'), which are asymptomatic and lack a therapeutic implication. The occurrence of excessive, symptomatic heterotopic ossification around the entry site of an antegrade femoral nail is rarely described in the literature.
  
  
  METHODS
  We present the case of a 28-year-old Caucasian woman who developed extensive heterotopic ossification around the reaming seeds of a reamed femoral nail. She developed severe pain and significantly impaired range of motion of the hip joint, requiring revision surgery for heterotopic ossification resection and adjunctive local irradiation. She recovered full function of the hip and remained asymptomatic at her two-year follow-up appointment.
  
  
  CONCLUSIONS
  Severe heterotopic ossification represents a rare but potentially detrimental complication after percutaneous femoral nailing of femur shaft fractures. Diligent care during the reaming procedure, including placement of a trocar to protect from osteogenic seeding of the soft tissues, may help decrease the risk of developing heterotopic ossification after reamed antegrade femoral nailing.
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver, CO, 80204, USA. philip.stahel@dhha.org.
authors.forename: Sergiu
authors.initials: S
authors.lastname: Botolin
authors.forename: Cyril
authors.initials: C
authors.lastname: Mauffrey
authors.forename: E Mark
authors.initials: EM
authors.lastname: Hammerberg
authors.forename: David J
authors.initials: DJ
authors.lastname: Hak
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
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