When to operate for heterotopic ossification?

When heterotopic ossification has formed, especially when it leads to dysfunction or even ankylosis, surgical resection is the only option for functional rehabilitation and reconstruction of the joint. Heterotopic ossification of limb joints after brain injury is a common clinical phenomenon, and after the occurrence of heterotopic ossification, it is generally considered more appropriate to carry out surgical resection after the heterotopic ossification has matured. The criteria for determining the maturity of heterotopic ossification include: alkaline phosphatase level returns to normal; heterotopic ossification has been present for 1-1.5 years; and X-ray radiographs show that the encapsulated bone outside of the heterotopic ossification is dense and clearly delineated. However, it should be noted that the alkaline phosphatase level cannot simply be taken as a conclusive indicator of whether the heterotopic ossification is mature or not, but should be judged according to the clinical synthesis. The principle is that when the condition of nerve injury is stable, active movement recovery is good, alkaline phosphatase level is basically normal, and X-ray radiographs show clear boundaries of heterotopic ossification, it should be resected as soon as possible. Clinical studies have found that different types of injuries require different time to stabilize, and traumatic brain injury is usually 16 months after injury.