[Bilateral hip ankylosis caused by heterotopic ossification after isolated severe craniocerebral trauma].

A 36-year old man suffered an isolated head injury with a fracture of the skull, epidural and subdural hematomas as well as brain contusion (Abbreviated Injury Scale (AIS): 5 points). The hematomas were evacuated by craniotomy. Because of high intracranial pressure (ICP) a barbiturate coma was necessary. Additionally, the patient demonstrated acute lung injury (ARDS) due to pneumonia 8 days after trauma. The patient recovered slowly and was transferred to neurorehabilitation on day 57 after injury. During the following 12 months the patient developed a significant deficit of hip motion (extension/flexion: right: 0 degree/10 degrees/20 degrees, left: 0 degree/10 degrees/30 degrees; external/internal rotation: right and left: < 5 degrees/0 degree/< 5 degrees; abduction/adduction: right: 10 degrees/0 degree/25 degrees, left: 10 degrees/0 degree/10 degrees). X-rays and CT-scanning revealed severe heterotopic ossification (HO) of both hips with ancylosis (Brooker type IV). Resection of HO was carried out in a two stage procedure using Smith-Petersen approach. The prophylaxis for recurrence of HO included preoperative single-dose radiation (8 Gy) and postoperative treatment with indomethacin (150 mg per day). The patient revealed 15 (left hip) and 12 (right hip) months after surgery the following range of hip movement: extension/flexion: right: 5 degrees/0 degree/90 degrees, left: 5 degrees/0 degree/100 degrees; external/internal rotation: right: 20 degrees/0 degree/30 degrees, left: 20 degrees/0 degree/20 degrees; abduction/adduction: right: 30 degrees/0 degree/40 degrees, left: 30 degrees/0 degree/40 degrees. No recurrence of HO was observed in x-ray. The patient is able to work in his profession as farmer.