Posttraumatic osseous metaplasia causing reversible palsy of the brachial plexus: case report and review of the literature

• Published in: European journal of plastic surgery Vol. 44; no. 6; pp. 849 - 852
• Main Authors: Redl, Elena, Bauer, Thomas, Dietl, Marion, Pierer, Gerhard, Djedovic, Gabriel
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021
• Subjects: Case Report; Medicine; Medicine & Public Health; Plastic Surgery; Brachial plexus palsy; Plexus neuropathy; Hematoma calcification; Myositis ossificans traumatica; Posttraumatic ossification; Osseous metaplasia
• ISSN: 0930-343X; 1435-0130
• DOI: 10.1007/s00238-021-01815-3

Myositis ossificans traumatica (MOT) describes a benign form of ectopic ossification of soft tissue, most commonly skeletal muscle, that occurs in reaction to trauma. Treatment is indicated if important neurovascular structures are compressed or displaced and in case of functional restrictions that hamper movements of daily life. We report the case of a patient who developed increasing palsy of the left deltoid and biceps brachii muscles 8 weeks after multiple injuries sustained in a car accident. Ultrasound and x-rays pointed towards a calcified mass compressing the left brachial plexus. Four months after the precipitating trauma, the mass was surgically resected. Surgical exploration and histopathology yielded the diagnosis of MOT. At a 3-month follow-up visit, the patient experienced complete functional recovery and has remained recurrence free. To our knowledge, this case represents the first report in which MOT caused complete brachial plexus palsy. The findings support the argument that surgical treatment for MOT does not have to be delayed until 6–12 months after the initial trauma to await full maturation. Clinical symptoms extending to complete palsy can result from posttraumatic ectopic calcification. Early surgical intervention in the case of persistence or deterioration of symptoms is indicated. A full remission of nerve and motor function is possible. Level of evidence: Level V, risk/prognostic study.