Better understanding of the biology of heterotopic ossification (HO) formation will lead to treatment and prevention modalities that can be directed specifically at the cellular level. Early identification of HO precursor cells and target genes may provide prognostic value that guides individualized prophylactic treatment. Better understanding of molecular signaling and proteomics variability will allow surgeons to individualize preemptive treatment to suppress inflammation and formation of HO. Careful surgical technique to avoid muscle damage is important. Damaged muscle should be debrided as a prophylactic measure. Hemostasis and avoidance of a postoperative hematoma may decrease the chance of formation of HO.
Key points
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Formation of heterotopic ossification (HO) is poorly understood but is an area of continued scientific investigation.
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Certain injuries and patient populations seem to have increased risk of HO formation.
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Brooker classification is most commonly used; however, the Hastings and Graham classification may be more useful around the elbow.
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Pharmacologic agents and radiation have been used in HO prophylaxis.
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Surgical excision is an option for established, symptomatic HO.
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