Ancylosis of both hips through heterotopic ossifications after isolated severe head injury

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