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Final Program


Final Program

1243 - Leg Circumference Discrepancy as an Early Indicator of Heterotopic Ossification in Patients with Spinal Cord Injury: A Case Series

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • Nicole C. Feng, MD

    Resident Physician
    Northwestern McGaw Shirley Ryan AbilityLab
    Chicago, Illinois, United States

    • Co-Author(s)

  • Chinenye C. Nnoromele, MD

    Assistant Professor
    University of Louisville/Frazier Rehabilitation Institute
    Louisville, Kentucky, United States

  • Allison B. Kessler, MD

    Section Chief, Spinal Cord Injury Medicine
    SRALab, Northwestern
    chicago, Illinois, United States

Case Diagnosis: Three adults in acute inpatient rehabilitation, each with a spinal cord injury (SCI) developed unilateral thigh swelling with subsequent identification of hip heterotopic ossification (HO).

Case Description: Three male patients aged 20-29 years with no significant prior medical history sustained spinal cord injuries resulting in thoracic paraplegia due to motor vehicle accidents and a spontaneous epidural hematoma. Each rehabilitative course was complicated by acute onset leg swelling with significant circumference discrepancy when compared to the contralateral thigh. Diagnostic testing included lower extremity duplexes, CTs to the lower extremities, and laboratory evaluation; all were largely unremarkable, although CTs noted nonspecific muscular edema surrounding the hip joint of the affected leg. A presumptive diagnosis of HO was made. The patients received pharmacologic management along with therapies focusing on range of motion. Eventually, both lab and imaging findings confirmed HO, but range of motion was preserved and thigh swelling resolved due to hyperacute intervention. These cases illustrate the use of thigh circumference discrepancy as an early marker of HO, allowing for early identification and management.

Discussions:

Up to half of individuals with SCI develop HO, predominantly affecting the hip. If left untreated, HO can lead to a significantly restricted range of motion, severely impairing mobility and function. Unfortunately, once the HO bone is fully formed, treatment options become limited and less effective. Therefore, early detection is crucial for optimizing outcomes.

Conclusions:

There are no studies to date that utilize leg circumference change as a sign of HO. In this case series, leg swelling was an initial symptom that allowed for early identification of HO and prompt treatment. Larger investigational studies should be undertaken to determine the reliability of leg circumference discrepancy as an early diagnostic sign of hip HO.