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Disruption of targeted muscle reinnervation due to heterotopic ossification in an amputated lower extremity
  1. Spencer R Anderson1,
  2. Nishtha Gupta2,
  3. Elise A Johnson3 and
  4. Ron Michael Johnson1
  1. 1Division of Plastic and Reconstructive Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio, USA
  2. 2Wright State University Boonshoft School of Medicine, Fairborn, Ohio, USA
  3. 3Ross University School of Medicine - Barbados Campus, Miramar, Florida, USA
  1. Correspondence to Dr Spencer R Anderson; spencer.anderson{at}


A patient in his late 40s presented after 1-year following below knee amputation and targeted muscle reinnervation (TMR) with new prosthesis intolerance and pinpoint pain, suspicious for neuroma. X-ray confirmed fibular heterotopic ossification (HO). Operative revision identified HO encompassing a TMR construct with a large neuroma requiring excision and neuroplasty revision. Now approximately 1-year post procedure, the patient remains active, pain-free and ambulating with a prosthetic. Amputated extremities can be at risk for development of HO. Although described in literature, the pathophysiology and timeline for HO development is not well understood. Preventative measures for HO have been described, yet results remain variable. The gold standard for existing HO remains to be operative excision. Due to the unpredictable nature and debilitating presentation, risk of HO should be incorporated into patient–physician discussions. Additionally, new prosthetic intolerance absent of prior trauma should raise suspicion for possible HO development.

  • Plastic and reconstructive surgery
  • Orthopaedic and trauma surgery
  • Physiotherapy (rehabilitation)

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  • Contributors SRA: Operative procedure, organisation, chart review, literature review, rough draft, revision, final draft and submission. NG: Chart review, literature review, rough draft and final draft. EAJ: Literature review and rough draft. RMJ: Preoperative assessment, operative procedure, postoperative care and final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.