CHAPTER 19
SOFT TISSUE CALCIFICATIONS AND
OSSIFICATIONS
Periostal and extraosseous calcifications of soft tissues are a common result of pressure
sores, if the infection penetrates into the deepest tissues including the bone, producing
osteitis and osteomyelitis. They are discussed in more detail in the Chapter on Pressure
Sores.
Repeated trauma of moderate degree to muscles, such as pressure and squeezing,
may lead to the development of circumscribed ossification in non-paraplegic individuals.
The most well-known examples are the 'Riderbone', which develops in the adductors
and the ossification in the deltoid muscle of soldiers from recoil of the gun during firing
practice.
Para-articular ossifications
A special form of para-articular ossification exclusively of non-infectious or traumatic
aetiology has been repeatedly observed in both complete and incomplete paraplegics and
tetraplegics below the level of the lesion. Although Riedel (1883) and Eichhorst (1895)
described this condition, it was Mme Klumpke-Dejerine and her co-workers (1918-19)
who made a detailed study on this subject in spinal paraplegic soldiers of the First World
War. Statistical data of the frequency of this condition vary considerably. Dejerine &
Ceillier (1919) found para-articular ossifications in 48-7 per cent, Soule (1945) in 37
per cent, Abramson (1948) and Abramson & Komberg (1949) in 41 per cent, Liberson
(1953) in 37 per cent, Damanski (1961) and Hardy & Dickson (1963) in 16 per cent,
Paeslack (1965) in 40 per cent, and Freehafer & Yurick (1966) in 17 per cent of their
patients. However, in some of the publications pathological ossifications of different
aetiologies (infection, osteomyelitis, fractures) are included, which may account for the
high percentages. In our own material, where local infection, pressure sores and fractures
are excluded as aetiological factors, the percentage is not higher than 5 per cent.
The predilection places of para-articular ossification are the medial border of the
femoral condyle, upper third of the femur, anterior part of the hip, middle and upper
part of the pelvis, medial and lateral aspects of the knees and the surroundings of the
elbow joint. The joints themselves remain unaffected, in contrast to their involvement
and destruction as a result of infection due to pressure sores. However, the para-articular
ossifications can become so massive, especially around the hip joints, that an extra-
articular ankylosis develops which, in due course, may prevent the patient from sitting
or, in the case of the elbow-joint its movement may become impossible. Since the Second
World War there has been an increase of publications on this subject (Brailsford, 1941;
Soule, 1945; Heilborn & Kuhn, 1947; Worms & Gougeon, 1947; Miller & O'Neil, 1949;
Poppe, 1953; McNear, 1954; Storey & Tegner, 1955; Finkle, 1956; Finkelman, 1956;
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