1420 - Treatment of Early Heterotopic Ossification following a Traumatic Amputation with Single Dose Radiation and Pamidronate: A Case Study

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

EC

Erika Castriz, MD

Resident Physician
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States
AN

Alexa Noronha, MD

Resident Physician
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States
CR

Claudia Russell, MD

Resident Physician
Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
Philadelphia, Pennsylvania, United States

Co-Author(s)

NA

Nethra Ankam, MD

Attending Physician
Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
Philadelphia, Pennsylvania, United States
MM

Marisa Moreta, DO

Attending Physician
Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
Philadelphia, Pennsylvania, United States

Submitter(s)

CR

Claudia Russell, MD

Sidney Kimmel Medical College At Thomas Jefferson University/TJUH PM&R Program
Philadelphia, Pennsylvania, United States

Case Diagnosis: 34-year-old male with complex medical history presented after gunshot wounds ultimately resulting in a transfemoral amputation complicated by uncontrolled pain due to early heterotopic ossification (HO) at the amputation site.

Case Description: Patient sustained distal left femur fractures with arterial injury requiring popliteal artery bypass of the left lower extremity, complicated by graft thrombosis. Non-salvageable limb ultimately underwent transfemoral amputation. Patient subsequently developed intractable pain of the residual limb. CT scan showed a collection abutting the distal femoral stump, suspicious for developing ectopic ossification. Triple phase nuclear medicine bone scan was consistent with immature HO at the residual limb site. Pre-treatment pain was severe with muscle spasms impacting sleep and unresponsive to medications. At the recommendation of the Physical Medicine and Rehabilitation team, he underwent one-time radiation therapy with Radiation Oncology. He then received a 5-day taper of pamidronate to further halt bone formation as didronel was not obtainable. After, pain significantly decreased, was responsive to opioid medications, and manageable throughout the day. His spasms fully resolved and sleep quality improved.

Discussions: Heterotopic ossification is a potential complication after traumatic amputation that can lead to pain, limited range of motion, and impact rehabilitation after injury. In a retrospective chart review of 444 patients with HO after spinal cord injury, single dose radiation was found to be a safe and effective option for treatment. Evidence remains limited for effective treatments for early HO in the amputee population. More studies are needed to determine efficacy.

Conclusions: Early diagnosis and treatment of HO can help reduce complications and improve function and participation in rehabilitation. It is critical to consider this diagnosis early when treating an amputee patient with uncontrolled pain. Single dose radiation therapy followed by a short course of Pamidronate infusions can be an effective treatment option for patients with uncontrolled pain due to early HO.