# A rare case of extensive neurogenic heterotopic ossification: a case report

## TL;DR

This case report describes a rare instance of extensive bone growth in soft tissues across all four limbs following a neurological injury, and the patient's recovery through surgery and rehabilitation.

## Contribution

The novelty lies in reporting a rare case of NHO affecting all four limbs and demonstrating functional improvement through surgical and rehabilitative interventions.

## Key findings

- The patient had NHO in all four limbs, causing severe mobility issues.
- After three surgeries and rehabilitation, the patient regained wheelchair mobility and upright posture.
- Multidisciplinary care is essential for managing NHO and improving functional outcomes.

## Abstract

Neurogenic Heterotopic ossification (NHO) is a potential sequalae and a detrimental complication following neurological insult. It is characterized by formation of localized gradually progressive, peri-articular lamellar bone formation in extra-skeletal tissues. We would like to report a rare case of heterotopic ossification involving all 4 limbs, in which we tried to restore joint mobility to improve his functional status so that he could perform his daily tasks.

We present a case of a 33-year-old bed ridden male, diagnosed with NHO involving all 4 limbs (bilateral hip, right knee, right shoulder, left elbow). The patient had a crippled posture, significant pain and impaired range of motion hampering movement of all four limbs which prevented him from lying down supine, sitting, walking and performing activities of daily living. After three surgeries, the patient achieved wheelchair mobilization and upright posture with the assistance of calipers.

The management of NHO requires a multidisciplinary approach involving orthopaedic surgeons, neurologists & rehabilitation specialists. Prognosis of NHO depends on factors such as extent of ossification, underlying neurological condition & patients overall health.