Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

18 SLIDING BACK ON TRACK: HETEROTROPIC OSSIFICATION

Eric O'Neal, MD; Nathaniel Coleman, MD; Kimberly Bird, MD Corresponding author: Eric.ONeal@LPNT.net

Sovah Health - Danville, Danville, Virginia

Context: Heterotropic Ossification (HO) is a phenomenon involving ectopic bone formation, demonstrated as myositis ossificans circumscripta, myositis ossificans progressiva, and localized traumatic myositis ossificans. Although a genetic predisposAclear at this time, this condition has been associated HLA-B18, HLA-B27, and HLA-DW7. Report of Case: We present a 27-year-old male who initially presented to the VA clinic for a follow-up. The patient’s condition started after he was admitted to the hospital after a MVC in 2013. The patient was the driver and was T-boned by another vehicle on the driver's side. The MVC caused the patient to become paraplegic and required contralateral hip surgery. His initial labs at the time of admission revealed hypercalcemia. Patient required multiple surgeries, consults with Plastic Surgery, and a long series of radiation to help with his symptoms. The patient is an overweight, Caucasian male sitting in a power chair. He recently had his foley catheter and wound vac changed for his back, and has been doing well overall. His most recent labs revealed an ALP, a marker for increased bone turnover.

Comments: The etiology of HO is unclear at this time, but this condition can occur post-op status post hip arthroplasties which an incidence of 16-53%. The wide variability can be attributed to the type of traumatic injury and the presence of spasticity. Other common risk factors include Hepatitis B vaccinations, Haemophilus influenzae vaccinations, and rubella. In regards for our patient, the MVC caused the patient to undergo a prolonged course of HO with post-traumatic HO formation all over his body. Imaging required for this condition includes a three-phase bone scintigraphy, demonstrating its highest sensitivity after 2-4 weeks. Additional studies suggest that indomethacin helps in delaying bone formation, serving as treatment option alongside calcitonin and methylprednisone. Another form of treatment includes bone morphogenetic proteins (BMPs), which help increase bone regeneration. However, risk factors that can lead to poor bone healing include multiple previous surgeries and multiple comorbidities. Our patient has not taken any BMPs to date due to multiple surgeries he has required from his prolonged course of HO. The patient continues to follow-up at the VA and still continues to improve his quality of life.

Heterotrophic ossification is a unique condition that is commonly associated with traumatic injuries. This condition is also associated with Albright hereditary osteodystrophy and progressive osseous heteroplasia. Diagnosis : Heterotropic Ossification, secondary to Myositis Ossificans Circumscripta, status post MVC References: [1] Prodoehl, J., Bakaes, Y., Tucker, M., Voss, F. Off-label: The results of adjunctive bone morphogenetic protein for challenging femur fracutres; a review of two cases. Trauma Case Reports 2024 Apr;50; e100979. [2] Bossche, L., Vanderstraeten, G. Heterotopic Ossification: A Review. Journal of Rehabilitation Medicine, 2005;37;e129-136.

Table of Contents

149 2026 Research Recognition Day